Hopefully, it doesn’t come as a shock to you, but Hawaii Insurance Companies are private businesses.  As such, they are driven by only one thing: PROFITS.  So, it should not come as a surprise to you when you find out that your insurance company isn’t eager to write checks to you when you submit a claim.  In fact, they are very good at figuring out ways not to write checks.  They would rather pay their adjustors a lot of money so that they work hard to avoid having to pay out when a claim is made.  We’ll discuss ways in which you can fight back to make sure your insurance company does what they are supposed to do.

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Let’s first discuss some of the tactics they use to deny claims.  When you’re injured in an auto accident, you will automatically have $10,000 in insurance benefits for your medical bills.  This is the minimum amount required by law in Hawaii.  This coverage is known as “No-Fault Insurance” or “Personal Injury Protection”.  Under the law, the insurance companies only have to pay for medical bills that are “reasonable” and “related” to your injuries from the accident.  As soon as you file the claim with the insurance company, the adjuster will call you wanting to take your recorded statement as soon as possible.  There are several reasons why they want to take your statement ASAP.  The first reason is that many injuries don’t show up for a day or two after the accident.  Strained and sprained muscles don’t usually manifest their injuries for a day or two.  Many people think that they are fine the first day but then wake up the next day in much pain.  This is why the insurance adjuster will want to take your recorded statement as quickly as possible before the injuries have manifested themselves.

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As stated above, insurance companies only have to pay for injuries that are related to the accident.  Therefore, if they take your statement on day one and you don’t mention an injury, then don’t expect them to pay for the treatment for that injury when it shows up in a day or two.  For this reason, we recommend that you wait for a few days to give a recorded statement to the insurance adjuster.  Preferably, you will hire a lawyer before you talk to the insurance company so that he can advise you on the best way to approach the recorded statement.

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When it comes to the recorded statement, the best advice we can give to clients is to be sure that they include every single injury, no matter how big or small.   Be as specific as possible with your injuries.  For example, if you say that your upper back hurts, then don’t expect the insurance company to pay for treatment for your middle or lower back.  If you only say that your pelvis hurts, don’t expect them to pay for treatment for your hip.  Yes, this sounds ridiculous, but these exact situations have actually happened.

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The relationship between you and your insurance company is known as a first-party relationship.  It’s based on the insurance contract between you and them.  You freely entered into this contract, and there are many things that you agreed to in the contract.  One thing that you agreed to is to cooperate fully when they are evaluating your claim.  Therefore, if they want to take your statement, you have to comply.  Another much more intrusive thing they can ask of you is to submit to an independent medical exam.  If you are receiving a lot of treatment and your insurance company is paying a lot of bills, they will certainly try to get out of continuing to pay for continued treatment.  One way for them to do this is to have you undergo an independent medical exam.  This is an exam with a doctor that they have chosen and that they pay for.  Almost all independent medical exams have the same result.  Nearly every time, the doctor will say that you don’t need any more treatment.

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It doesn’t take a genius to figure out why these doctors almost always come to the conclusion that the insurance company wants them to.  Simply put: the insurance company is paying for the exams, and if the doctors don’t tell the insurance companies what they want, then they won’t be hired for future exams.

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Every once in a while, we do come across an honest doctor who comes back with an honest evaluation of the client’s need for continued medical care.  Sadly, these occurrences are rare.

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Another item that is just as important as the recorded statement is the application for personal injury protection benefits.  This is an application that must be completed before the insurance company can begin to provide medical benefits.  Just like with the recorded statement, you will want to be as thorough and specific as possible on that application.  Do not be surprised if the insurance company refuses to pay for treatment for an injury that is not specifically stated on the application.

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One of the complicated parts of an injury case in Hawaii is medical liens. Most of us have health insurance, and we think that our health insurance company simply pays the bills they receive and will never ask to be reimbursed for bills that they’ve paid. This assumption is usually true; however, one exception is when you’ve been involved in an auto accident in Hawaii. The medical insurance companies in Hawaii, such as HMSA, Kaiser, and HMAA, have clauses in their insurance contracts that state that if you’ve been injured in an accident and you receive compensation for those injuries, then you have to pay them back for the bills that they’ve paid. The initial reaction by most people is that this isn’t right. You pay your health insurance premiums and expect your insurance company to pay the bills and not ask to be reimbursed when you settle your injury case. We can also look at it from the medical insurance company’s point of view: they lost money because of the bad driver, so they think they have the right to be compensated for their losses.

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These health insurance companies hire collection companies to try to get the money back that they’ve spent on someone’s injuries due to an accident. The agents for the collection companies receive commissions based on how much they get back from the health insurance companies. One of the techniques of the collections companies is to do anything they can to get information about the car insurance companies involved in the case. Their main goal is to place a lien on the case with the car insurance companies. Once a lien is placed on the case, then the car insurance adjusters won’t settle the case unless the injured person agrees to have them take out the medical lien amount from their settlement proceeds and pay the collection company the amount they’ve requested.

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We do everything that we can to get the collection companies to discount the amounts that they’re requesting. If the collection company has placed the car insurance company on notice of their lien, then it is very difficult to get them to reduce their lien. This is because they know that they are in a position of power. They know that the case can’t be settled until their lien is resolved. In these situations, they will usually only reduce their lien by about 10% at the most. If the collection company hasn’t placed the car insurance company on notice, then we are in a much better position to get them to reduce their lien amount. This is because they know that we’re the ones in the position of power. When we settle the case, the client will usually request that we hold funds from the settlement in our client trust account to resolve the outstanding liens. We can then take as much time as we need to get the collection company to reduce their lien. In these situations, we can usually get them to reduce their lien by about one-third.

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This is an area of law that is constantly changing. There was a recent Hawaii Supreme Court decision that greatly limited the ability of health insurance companies to get compensation for the medical bills that they paid. Whether the health insurance plan is an ERISA plan or not makes a big difference in how much of the medical bills have to be paid back.

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Medical liens from Med-Quest (Department of Health Services) are supported by statute, but the good thing about Quest liens is that they are required to be reduced by one-third. Quest liens are known as super liens because statutory law requires that they are paid back.

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Medical liens from Medicaid, Medicare, and Tricare are also considered to be super liens because federal law requires that they are paid.

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Each of these different health insurance companies and government agencies has different processes and procedures for requesting reductions and paying back liens.