NO. 28899 - Wednesday, April 8, 2009 - 9 a.m.
HAWAII MEDICAL SERVICE ASSOCIATION, Appellant-Appellant, v. BRENT ADAMS; and THE INSURANCE COMMISSIONER and THE DIVISION OF INSURANCE, of the DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS; STATE OF HAWAI`I, Appellees-Appellees.
Attorney(s) for Appellant-Appellant
Ellen Godbey Carson, Dianne Winter Brookins and Jason H. Kim (Alston Hunt Floyd & Ing)
Attorney(s) for Appellee-Appellee, Brent Adams
Arleen Jouxon-Meyers and Rafael G. Del Castillo (Jouxon-Meyers & Del Castillo)
COURT: Watanabe, Foley and Fujise, JJ.
SPECIAL NOTE: The above argument will take place in the Supreme Court courtroom on the Second Floor of Ali`iolani Hale, 417 South King Street, Honolulu, Hawai`i.
In a secondary appeal, Appellant-Appellant Hawaii Medical Service Association (HMSA) appeals from a judgment entered by the Circuit Court of the First Circuit (circuit court) in favor of Appellees-Appellees Brent Adams (Adams) and the Insurance Commissioner and the Division of Insurance of the Department of Commerce and Consumer Affairs, State of Hawai`i (DCCA) (collectively, the Commissioner).
Adams purchased health insurance from HMSA, but was denied coverage for a particular medical procedure. The Commissioner ordered HMSA to provide coverage for the medical procedure. The circuit court affirmed in part and reversed in part the Commissioner's order, primarily affirming it. The circuit court reduced its dispositive order to a separate judgment in favor of Adams and the Commissioner and against HMSA. On appeal, HMSA argues that the circuit court erred by (1) applying a "palpably erroneous" standard of review rather than the standards mandated by Hawaii Revised Statutes (HRS) § 91-14(g); (2) affirming the Commissioner's interpretation that HRS § 432E-1.4 required HMSA to specifically state in Chapter 6 (Services Not Covered) of HMSA's Preferred Provider Plan for the Hawai?i Employer-Union Health Benefits Trust Fund that "allogeneic bone marrow transplant for treatment of multiple myeloma" was excluded from coverage; (3) affirming the Commissioner's reliance on evidence that was not available to HMSA and disregarding evidence on which HMSA reasonably relied in holding the Commissioner's conclusion that HMSA did not act reasonably at the time of its final internal decision to deny coverage to Adams; and (4) affirming the Commissioner's finding of bad faith by HMSA, while reversing the factual findings on which the Commissioner relied to support such a determination.