1.  You Don’t Reach the Tort Threshold

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As has been discussed on many of our website pages, to 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 more extended tort liability in Hawaii except in a few certain circumstances.  One of these circumstances is when the No-Fault insurance pays at least $5,000 in medical bills. 

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Sometimes it can be challenging to reach the “tort threshold”.  One situation may be if the No-Fault insurance pays a tiny percentage of the medical bill.  For example, your emergency room bill may be $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 pay the entire $10,000 bill, while others will pay only a portion.  Remember that the tort threshold is based on bills paid, not just the total billed amount.   

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

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Another situation that causes significant 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 tiny portion of the medical bill.  Therefore, even if the No-Fault insurance pays Tricare, they must pay 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, you should quickly reach the tort threshold.  If you don’t go to the ER or go to cheap urgent care, you may have difficulty 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 they may 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 medical insurance companies wanting to be reimbursed for the bills they paid.  

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Sometimes medical liens can prevent you from settling your case.  Some insurance adjusters 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 backed 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 they can also take a very long time for these Federal agencies even to tell us how much their lien is.  Medicare uses an outside agency to handle the liens, which usually only takes 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 to 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 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, the case may not even settle because it wouldn’t make sense for someone to settle their case and then have to give a large portion of the proceeds back to the government.  

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

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Here we’ve discussed only a few ways your good Hawaii car accident case can go from good to bad.  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. 

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What You Don't Know About Car Accident Cases In Hawaii

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Many aspects of Hawaii’s injury cases are common sense.  Everyone knows that the person who hit you is responsible for fixing your car, reimbursing you for your medical bills, and paying you for your pain and suffering.  Of course, this is usually all paid by their insurance company.

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Here is something that many people don’t know about car accident claims in Hawaii:

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You must pay your health insurance company back when settling your injury claim.

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This comes as a shock to many people. Most people who have been injured in an accident have no idea that their health insurance company wants to be paid back for the bills they paid for their treatment related to the accident. The prominent health insurance companies in Honolulu and throughout Hawaii even hire companies that specialize in obtaining reimbursement for the medical bills they paid.

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As Hawaii injury lawyers, we receive many phone calls from these companies and respond to their letters. Their agents receive a commission for the funds they recover, which allows them to be aggressive.

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Don’t worry, you only need to reimburse your health insurance company if you receive a settlement for your injuries.  If you decide not to pursue the matter and don’t get a settlement, you don’t need to pay back the insurance company.

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This phenomenon of medical insurance companies wanting to be reimbursed is somewhat new.  Many years ago, this was not an issue.  Now their right to be compensated when the injured person gets a settlement is explained in the insurance contract.  These contracts indicate that the insureds must cooperate with the medical insurance company and ensure they are paid back when their case is settled.

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This is a good reason to hire a Honolulu accident injury lawyer with many years of experience. Attorneys without experience with car accident claims may not even know that the medical insurance company will want to be paid back.

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It is essential to know the amount that needs to be paid back so that you can consider it when accepting a settlement amount.  You should not take a settlement amount until you have considered how much the settlement will be paid to the medical insurance company and how much will be paid for the attorney fees.  You don’t want to be surprised if you discover that you receive less than you thought.

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An experienced injury lawyer will also know how to negotiate with the medical insurance company to get them to reduce the amount they request.  For example, we can usually get them to reduce it by the percentage paid for attorney fees.  After all, the client had to hire a lawyer and pay attorney fees to get compensated, so why should the health insurance company not have to reduce their balance by at least the same percentage that the client had to pay for their attorney fee?

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The laws in this area are constantly evolving.  This is an issue that is continually being challenged in the courts.  Recently, injury lawyers have been successful against health insurance companies who are seeking reimbursement.  The Supreme Court of Hawaii and the Federal District Court of Hawaii have both ruled in favor of the injury lawyers and against the health insurance companies.  This is great news for victims of injuries in Hawaii; however, the fight is not over yet.  The health insurance companies have vowed to continue to fight the issue in court and have indicated that they will appeal the cases to higher courts.

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To hear the oral arguments in one of the recent lawsuits against one of the health insurance companies in Hawaii, click here.  To read the court decision, click here.

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Understandably, they would want to be reimbursed for some of what they have paid.  For example, if someone received a million-dollar settlement because their medical bills were hundreds of thousands, it would be reasonable for the health insurance company to receive some of the settlement.  However, the problem is that these health insurance companies are often very unreasonable.  For example, most people in Hawaii only have the minimum car insurance of $20,000.  So most settlements for injuries are $20,000 or less.

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The health insurance company sometimes paid $15,000 in medical bills, but our client only received the policy limits of $20,000.  After our client paid the attorney fees of $6,600, they had $13,300 left of the settlement.  Then the health insurance company asks for all our clients' money in the settlement.  How ridiculous is that?  Even if our client got to keep all the $13,300, they still didn’t receive all the compensation they deserved because of the low policy limits.  In this example, paying the insurance company back about $3,000 would be reasonable.  Unfortunately, they aren’t usually very reasonable.  They almost always want to be fully compensated.

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In a perfect world, the policy limit requirements in Hawaii would be at least $100,000. That would enable most people injured in accidents to receive the compensation they deserve. However, it wouldn’t be possible to pay back the health insurance company for what they paid.

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As long as we live in a world with small policy limits of $20,000, it is reasonable for personal health insurance companies to be paid back for what the injury victim receives after paying his/her attorney fees.  This would be reasonable.  Until the health insurance companies decide to be more sensible, we will continue fighting tooth and nail to get our clients maximum compensation for their injuries.

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This is just one aspect of injury claims in Hawaii that many people may not be aware of.  Check out our other Honolulu injury resources webpages for more critical information about auto accident cases.​​