1.  You Don’t Reach the Tort Threshold

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As has been discussed on many of the pages of our website, in order to make a claim for pain and suffering, No-Fault Insurance has to pay at least $5,000 of your medical bills.  The $5,000 amount is known as the “Tort Threshold”.  Hawaii state law has abolished tort liability in all cases involving less than $5,000 in medical bills paid by the No-Fault Insurance.  Click here for the Hawaii Statute which abolished tort liability.  This Statute indicates that there is no longer tort liability in Hawaii except for in a few certain circumstances.  One is these circumstances is when the No-Fault insurance pays at least $5,000 in medical bills. 

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Sometimes it can be very difficult to reach the “tort threshold”.  One situation may be if the No-Fault insurance pays a very small percentage of the medical bill.  For example, your emergency room bill maybe $10,000, but perhaps the No-Fault insurance may only pay $1,000 of the bill.   Each No-Fault insurance company is different.  Some will simply pay the full $10,000 bill, while others pay only a portion of the bill.  Keep in mind that the tort threshold is based on bills paid, not just the total billed amount.   

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Some of rental car companies are notorious for paying a very small portion of the bill.  For example, we recently had a rental car company that only pay $1,500 of the $24,000 ER bill.  Needless to say, we are having a very difficult time reaching the tort threshold in that case.  

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Another situation that causes major issues in a case is when the medical provider refuses to bill the No-Fault insurance.  For example, The Queen’s Medical Center has recently changed its’ policy regarding active duty military personnel.  Queen’s refuses to bill their No-Fault insurance.  They will only bill Tricare.  Then, they expect Tricare to submit their bill to the No-Fault insurance for reimbursement.  The problem with this scenario is that Tricare pays a very small portion of the medical bill.  Therefore, even if the No-Fault insurance pays Tricare, the amount that they have to pay is only about 10% of the bill.   

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Going to the emergency room is one of the best ways to reach the tort threshold.  ER bills are usually about $5,000 or more.  Assuming you have a good No-Fault insurance company (also known as Personal Injury Protection) that pays a fair amount of the ER bill than you should quickly reach the tort threshold.  If you don’t go to the ER or you simply go to cheap urgent care, then you may end up having a difficult time reaching the tort threshold.  You will then end up having to get extensive physical therapy, massage therapy, chiropractic care, etc., in order to try to reach the tort threshold.   These therapies are only about $100 per treatment, so you can imagine how many treatments it would take to get up to $5,000 in bills.  One good way to incur larger medical bills is to undergo an MRI.  MRIs are usually about $1,000.  

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Some people may have a very difficult time attending a lot of therapy.  This is understandable considering the employment and family obligations may people have.  However, you should keep in mind that attending therapy will not only help you reach the tort threshold, which could result in an injury settlement, but it will also help you recover fully from your injuries.  

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2.  You Have Extensive Medical Liens On Your Case

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Although medical liens don’t technically cause you to lose your injury case, they can have a similar effect.  Medical liens can either be due to unpaid medical bills or due to medical insurance companies wanting to be reimbursed for the bills that they paid.  

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Sometimes medical liens can prevent you from settling your case.  Some insurance adjustors may insist that medical liens are resolved at the time of the settlement.  Some adjusters are overly worried about “super liens” such as those supported by Federal or State Law.  The medical liens supported by Federal law are for Medicare, Medicaid, Tricare, etc.  Federal law requires that these entities be paid back for the bills paid for injuries related to the accident.  Not only can these Federal liens take up a large part of the settlement proceeds, but it can take a very long time for these Federal agencies to even tell us how much their lien is.  Medicare uses an outside agency to handle the liens, so they usually only take about 3-4 months.  Tricare, on the other hand, can take one to two years.   How ironic is it that these Federal agencies insist on getting a chunk of the settlement proceeds but they are in no hurry whatsoever to even tell us how much they want.  

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Not only do these agencies take forever to tell us how much their lien is, but they can be totally unreasonable when it comes to being willing to reduce their liens.  They don’t understand that if they aren’t willing to reduce their lien, then the case may not even settle because it wouldn’t make sense for someone to settle their case and then just have to give a large portion of the proceeds back to the government.  

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Hawaii State law also requires that any payments made by Med-Quest must also be reimbursed.  Thankfully, the state doesn’t take very long to tell us how much they’ve paid.  They usually only take about a month.  Also, under State law, they have to reduce their lien by a third to help pay for the attorney fees.  

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Here we’ve discussed only a couple of the ways that your good Hawaii car accident case can go from good to bad, to worse.  Check out some of our other pages to learn more about how our Honolulu auto accident lawyers can help you get the maximum compensation you deserve for your auto collision injuries.