No. SCWC-12-0000645, Thursday, January 21, 2016, 8:45 a.m.

HANNAH HARRISON, Respondent/Petitioner-Appellant/Appellant, vs. GORDON I. ITO, INSURANCE COMMISSIONER, DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS, STATE OF HAWAI`I, Respondent/Respondent-Appellee/Appellee, and EVERCARE, Petitioner/Respondent-Appellee/Appellee. (CAAP-12-0000645; CIV. NO. 11-1-2903; HER-11-156920)

JENIVIE DELOS REYES, FRANKLIN BIDDINGER, FLOYD HAYES, JOHN VILLANUEVA, and TEHINE AVILLA, Respondents/Petitioners-Appellants/Cross-Appellees/Appellants, vs. GORDON I. ITO, INSURANCE COMMISSIONER, DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS, STATE OF HAWAI`I, Respondent/Respondent-Appellee/Appellee, and EVERCARE, Petitioner/Respondent-Appellee/Cross-Appellant/Appellee. (CAAP-12-0000646; CIV. NO. 11-1-2553; HER-11-156817, 11-156241, 11-156361, 11-156251 & 11-155841)

AUDREY DELOS SANTOS, Respondent/Petitioner-Appellant/Appellant, vs. GORDON I. ITO, INSURANCE COMMISSIONER, DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS, STATE OF HAWAI`I, Respondent/Respondent-Appellee/Appellee, and EVERCARE, Petitioner/Respondent-Appellee/Appellee. (CAAP-12-0000647; CIV. NO. 11-1-2542; HER-10-154685)

The above-captioned case was set for argument on the merits at:

Supreme Court Courtroom
Ali`iolani Hale, 2nd Floor
417 South King Street
Honolulu, HI 96813

Attorneys for Petitioner Evercare:

Dianne Winter Brookins and Morgan Early

Attorney for Respondents Hannah Harrison, et al.:

Rafael G. Del Castillo

NOTE: Order accepting Application for Writ of Certiorari, filed 11/24/15.

COURT: MER, CJ; PAN, SSM, RWP, and MDW, JJ.

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Brief Description:

Petitioner/Respondent-Appellee-Cross-Appellant/Appellee

UnitedHealthcare Insurance Company formerly doing business as Evercare (Evercare) applies for writ of certiorari, challenging the Intermediate Court of Appeals’s (ICA) August 19, 2015 Judgment issued pursuant to its June 30, 2015 Memorandum Opinion. The ICA vacated Final Judgments of the Circuit Court of the First Circuit (circuit court) that were entered on June 20, 2012 in Civil No. 11-1-2903-11, Civil No. 11-1-2542-10, and Civil No. 11-1-2533-10.

This appeal arises from various requests for the Insurance Commissioner (or the Commissioner) to conduct external reviews of adverse determinations by Evercare regarding medical coverage of its enrollees. Hawai`i Revised Statutes (HRS) § 432E-6, which was repealed in 2011, governs such requests. In these cases, pursuant to subsections (a) and (e) of HRS § 432E-6, the Commissioner took various actions without holding a hearing. When the enrollees appealed the Commissioner’s orders to the circuit court pursuant to HRS § 91-14(a), the circuit court dismissed the appeals for lack of subject matter jurisdiction because HRS § 91-14(a) only allows for judicial review of contested cases. The circuit court concluded that because the Commissioner was not required by law to hold a hearing prior to his decisions in these cases, the proceedings were not contested cases.

The appellants appealed the circuit court’s dismissal to the ICA, where the cases were consolidated. The ICA did not consider whether the Commissioner was required by law to hold a hearing prior to decision making, but relied on Hawai`i Management Alliance Association v. Insurance Commissioner, 106 Hawai`i 21, 100 P.3d 952 (2004) to hold that the circuit court did have subject matter jurisdiction. The ICA vacated the circuit court’s dismissal in all of the consolidated cases and remanded for further proceedings.

In its Application for Writ of Certiorari, Evercare argues that the ICA gravely erred in holding that the circuit court had subject matter jurisdiction over the consolidated cases. Evercare presents the following two questions to this court:

1. Whether the circuit court properly dismissed the three underlying agency appeals for lack of subject matter jurisdiction on the basis of this Court’s well-established precedent regarding the limitations on subject matter jurisdiction over agency appeals.

2. Whether the ICA erred in concluding that the decision in Hawai`i Management Alliance Association v. Insurance Commissioner, 106 Hawai`i 21, 100 P.3d 952 (2004) controlled its decision in this appeal.