§431:10C-212  Administrative hearing on insurer's denial of claim.  (a)  If a claimant or provider of services objects to the denial of benefits by an insurer or self-insurer pursuant to section 431:10C-304(3)(B) and desires an administrative hearing thereupon, the claimant or provider of services shall file with the commissioner, within sixty days after the date of denial of the claim, the following:

     (1)  Two copies of the denial;

     (2)  A written request for review; and

     (3)  A written statement setting forth specific reasons for the objections.

     (b)  The commissioner has jurisdiction to review any denial of personal injury protection benefits.

     (c)  The commissioner shall:

     (1)  Conduct a hearing in conformity with chapter 91 to review the denial of benefits;

     (2)  Have all the powers to conduct a hearing as set forth in section 92-16; and

     (3)  Affirm the denial or reject the denial and order the payment of benefits as the facts may warrant, after granting an opportunity for hearing to the insurer and claimant.

     (d)  The commissioner may assess the cost of the hearing upon either or both of the parties.

     (e)  Either party may appeal the final order of the commissioner in the manner provided for by chapter 91. [L 1987, c 347, pt of §2; am L 1992, c 124, §7; am L 1997, c 251, §35]


Case Notes


  The first party to choose a forum for resolution of no-fault dispute binds the other party to that forum unless the circuit court finds that the parties have entered into a mandatory and binding arbitration agreement.  86 H. 59, 947 P.2d 371 (1997).

  1992 amendment to subsection (a) applies to claims arising from injuries sustained in accidents occurring before January 1, 1993; thus, provider had standing to contest insurer's denial of no-fault insurance benefits.  90 H. 1, 975 P.2d 211 (1999).