Yukumoto v. Tawarahara.

400 P.3d 486, 140 Haw. 285
CourtHawaii Supreme Court
DecidedMay 26, 2017
DocketSCAP-15-0000460
StatusPublished
Cited by4 cases

This text of 400 P.3d 486 (Yukumoto v. Tawarahara.) is published on Counsel Stack Legal Research, covering Hawaii Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Yukumoto v. Tawarahara., 400 P.3d 486, 140 Haw. 285 (haw 2017).

Opinion

OPINION OP THE COURT BY

RECKTENWALD, C.J.

This case presents an issue of first impression: whether health insurers have subrogation rights against third-party tort-feasors who cause injury to their insureds. For the following reasons, we conclude that a health insurer does not have a broad, unrestricted right of subrogation, but rather is limited to reimbursement rights established by statute.

I. Background

A. The Accident

This case arises from an accident that occurred on March 20, 2014, when Gregory Yukumoto was driving his moped in Honolulu. Ruth Tawarahara, who was driving an SUV, attempted to make a left turn in front of Yukumoto, and struck him with her vehicle. Yukumoto sustained serious injuries, including brain injury, traumatic hemorrhagic shock, acute respiratory failure, left tibial fracture, right fibula fracture, L2 compression fracture, multiple wounds, and multiple hematomas.

B. Circuit Court Proceedings

Gregory Yukumoto and his wife, Diane, filed a complaint against Ruth Tawarahara in the Circuit Court of the First Circuit. Hawaii Medical Service Association (HMSA) subsequently filed its “Notice of Claim of Lien,” contending that HMSA had paid $325,824.33 for medical expenses associated with Yukumoto’s injuries as of September 20, 2014.

The Yukumotos filed a Petition for Determination of Validity of Claim of Lien by HMSA pursuant to Hawaii Revised Statutes (HRS) § 663-10 (Petition). According to the Petition, Yukumoto’s wage loss and general damages claim was “approximately $4,000,000.” The Yukumotos contended that Ruth Tawarahara had only $1,100,000 of insurance coverage through a State Farm Insurance policy, which State Farm agreed to pay “pursuant to a general damages only release.” The Yukumotos and Tawarahara had agreed to their settlement on November 6, 2011. Tawarahara did not admit fault for the accident, Coupled with a $50,000 “under-insured motorist claim” that the Yukumotos submitted to GEICO Insurance, the Petition contended that the Yukumotos’ “total recovery, before payment of attorneys’ fees and costs, was $1,150,000” and that “[t]hey remain undercompensated by approximately $2,850,000.” Gregory Yukumoto’s HMSA health insurance was provided through his employer, the State of Hawaii.

The Yukumotos sought “a ruling that HMSA has no lien nor subrogation rights in their personal injury settlements because HMSA cannot satisfy the provisions of’ HRS § 663-10. 1 They alleged that under HRS *288 § 663-10, “[f|or a health insurer to receive any portion of a plaintiffs recovery from the defendant, the health insurer has the burden of proving that the settlement or recovery duplicates medical expenses that were paid by the health insurer.”

Lienor HMSA filed a memorandum in opposition, arguing that the Petition should be denied because HRS § 663-10 “does not abrogate HMSA’s contractual lien or subrogation rights, but rather provides HMSA with an independent statutory right to assert its lien on any amount that [the Yukumotos] recover.” (Emphasis in original.) HMSA also filed an Amended Notice of Claim of Lien for the amount of $337,351.79, and a motion to intervene in the action.

At a hearing on the Petition, the court requested that the parties submit supplemental briefing on the legislative history and intent of HRS § 663-10. 2 Following the sub-mittal of the supplemental briefing, the court held another hearing. At that hearing, HMSA contended that its “rights under 663-10 to be reimbursed by Plaintiffs ... are greatly facilitated by intervention” because it would be able to make “formal discovery requests.” HMSA represented that the purpose of the discovery would be to assist the court in making its “determinations under [HRS §] 663-10” as to whether there was any duplication between the settlement funds paid by Tawarahara and the medical expenses paid by HMSA. The Yukumotos contended “that Hawaii’s Unfair Claims Practices Act makes it illegal and an unfair claims practice to limit the coverage to a Plaintiff who has a third-party claim.” They argued that HRS § 431:13-103(10) was “specifically applicable to mutual benefit societies and HMSA[,]” and HMSA was violating the statute by “ ‘refusing to provide or limiting coverage available to an individual because the individual may have a third-party claim.’” The Yukumotos further maintained that HRS § 663-10 was an “anti-subrogation statute” and HMSA’s exclusive remedy, and that the legislative history of HRS § 663-10 supported their position.

The court orally granted HMSA’s motion to intervene at the hearing and subsequently filed an order limiting discovery to “what is contemplated under HRS § 663-10.” The court also ruled that HRS § 663-10 abrogated HMSA’s right of subrogation against Defendant Tawarahara, holding that the statute provided HMSA’s exclusive remedy “in this particular type of situation,” based on “the statute itself, the legislative history, and the absence of any particular ease law[.]”

HMSA filed its complaint in intervention (Complaint) in January 2015. HMSA con *289 tended that it was a mutual benefit society as defined in HRS Chapter 432 and that it was a “ ‘lienholder or person claiming a lien’ pursuant to applicable laws, including but not limited to HRS § 663-10, and has rights of subrogation and other reimbursement rights arising from its contract with Plaintiff Gregory Yukumoto and at common law.” HMSA asserted that it had “extended benefits on behalf of Plaintiff Gregory Yukumoto in the amount of $339,255.40 as of January 5, 2015.” HMSA sought judgment against Defendant Tawarahara in the sum of $339,255.40 “with interest thereon at the rate of 10% per an-num from date of judgment until paid,” as well as payment of its fees and costs. HMSA also filed a separate complaint against Ta-warahara, seeking to ensure its subrogation claim was preserved and to obtain payment of medical benefits it extended on behalf of Mr. Yukumoto.

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Bluebook (online)
400 P.3d 486, 140 Haw. 285, Counsel Stack Legal Research, https://law.counselstack.com/opinion/yukumoto-v-tawarahara-haw-2017.