Hawaii Health Insurer Reimbursement: What the Law Says and What We Could Not Confirm

By the FigureMyTax Editorial Team · How we calculate

We did not find a Hawaii statute that adopts the made-whole doctrine or limits a health insurer's reimbursement from your recovery. Hawaii does set a fifty per cent rule for no-fault insurers and a one-third cap for Medicaid.

What the made-whole doctrine is

The made-whole doctrine says an insurer that paid your bills cannot be repaid from your recovery until you have been fully compensated for your losses. Some states enact it by statute; others leave it to courts or to the insurer's contract. We searched the Hawaii provisions we read on liens, no-fault and Medicaid and found no such rule for a health insurer.

What the no-fault law does say

When a tort recovery duplicates personal injury protection benefits already paid, the motor vehicle insurer is reimbursed fifty per cent of the PIP benefits paid to or for you, up to the maximum limit (HRS 431:10C-307). That is a fixed share, not a made-whole rule. Under the no-fault law, benefits are payable without regard to fault (431:10C-304).

A worked example

Say your health plan paid $9,000 and you recover $100,000 with a one-third fee and $3,000 in costs. With no statute to limit it, the plan could claim the full $9,000 under its terms, and the Hawaii medical lien calculator shows it as an upper bound. A reduction for your share of fees and costs is something to ask the plan for in writing; for a self-funded employer plan, federal law may control.

What to do

Ask the plan or insurer for an itemized claim and its plan document, and ask whether it will reduce the claim for your attorney fees and costs and for the fact that you are not fully compensated. We did not read Hawaii court decisions on these points, so confirm with an attorney. See how provider liens, no-fault insurers and plans differ and how Medicaid and Medicare recover.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Hawaii's rules apply to your specific case with a licensed Hawaii attorney.