In the Yukumoto v. Tawarahara case the Supreme Court of Hawaii heard the important issue of whether a health insurance company has the right to subrogate against a TPL (third-party liability) Defendant. The Plaintiff in Yukumoto was riding his moped when he was hit by the Defendant in his car. The Plaintiff had very serious injuries. There was a brain injury, respiratory failure, both legs were fractured, and his spine was fractured. The Plaintiff got One Million One Hundred Thousand ($1,100,000) from the Defendant’s bodily injury insurance and Fifty Thousand ($50,000) from his own Under Insured Motorist policy.
The Plaintiff only made a claim for damages to himself and his wife for wage loss and “general damages” and valued the total amount of damages at approximately $4,000,000. The Hawaii Medical Service Association (HMSA) was NOT happy. They worked to get the Hawaii courts to enforce the Plaintiff’s health insurance company’s right to a lien and for subrogation rights for the full amount of the past paid medical bills ($325,824.33.) However, when the Judge read over the settlement documentation between the Plaintiff and the Defendant, they just noted that the Defendant paid the money for “general damages only.” That was enough proof for the Judge to find that none of the settlement funds were tendered to the Plaintiff by the Defendant for past medical bills.
The challenge then turned to a battle between whether the health insurance contract between the Plaintiff and the health insurer was the controlling document or whether the Federal Statute was the controlling statute. The contract language should never prevail over a Federal Statute which means the health insurer was not going to win that battle. The Hawaii Supreme Court then asked the Hawaii State Supreme Court to hear this personal injury case. The Hawaii State Supreme’s ruling affirmed the trial court’s ruling and allowed 100% of the settlement funds to be provided to the Plaintiff and the health insurer got zero ($0.00).