Oral Argument Before the Hawaii Supreme Court–No. SCWC-15-0000396
No. SCWC-15-0000396, Friday, January, 11, 2019, 10 a.m.
PATRICIA E. G. ADAMS, in her Capacity as Personal Representative of the Estate of Brent Adams, and in her Personal Capacity, Petitioner/Plaintiff-Appellant, vs. HAWAII MEDICAL SERVICE ASSOCIATION, Respondent/Defendant-Appellee.
The above-captioned case has been set for argument on the merits at:
Supreme Court Courtroom
Aliʻiolani Hale, 2nd Floor
417 South King Street
Honolulu, HI 96813
Attorneys for Petitioner:
Rafael G. Del Castillo of Jouxson-Meyers & Del Castillo; Robert H. Thomas, Tred R. Eyerly, and Joanna C. Zeigler of Damon Key Leong Kupchak Hastert
Attorneys for Respondent:
Dianne Winter Brookins and John-Anderson L. Meyer of Dentons US LLP
NOTE: Certificate of Recusal, by Chief Justice Mark E. Recktenwald, filed 09/05/18.
NOTE: Order assigning Circuit Court Judge Rowena A. Somerville, in place of Recktenwald, C.J., recused, filed 09/19/18.
NOTE: Order accepting Application for Writ of Certiorari, filed 10/17/18.
NOTE: Order granting request for rescheduling of oral argument from 12/18/18 to 01/11/19 at 10:00 a.m., filed 11/14/18.
COURT: PAN, Acting C.J., SSM, RWP, and MDW, JJ., and Circuit Court Judge Somerville, in place of Recktenwald, C.J., recused.
In late 2005, Brent Adams (Brent) sought a tandem autologous-allogenic bone marrow transplant to treat his aggressive cancer. At the time, Brent was insured by Respondent-Appellee Hawaiʻi Medical Service Association (HMSA). Over the course of the next few months, Brent and his wife Patricia Adams (Patricia) communicated with HMSA to determine the best course of treatment.
Brent submitted a formal pre-certification request to HMSA for the allogenic phase of the transplant on March 2, 2006. HMSA denied the request four days later, on March 6, 2006. Brent and Patricia subsequently challenged this determination before the Insurance Commissioner of the Department of Commerce and Consumer Affairs, the Circuit Court of the First Circuit, and the Intermediate Court of Appeals.
On certiorari, Petitioner-Appellant Patricia, in her capacity as personal representative of the estate of Brent Adams and in her personal capacity, argues that HMSA had a duty to act in good faith and fair dealing. She alleges that this duty first arose when HMSA became aware that Brent would pursue the allogenic transplant–as early as December 2005. She claims that HMSA breached this duty when it failed to notify Brent that the allogenic transplant was not covered under his insurance plan.
HMSA claims that its duty to act in good faith and fair dealing arose once Brent complied with the claims procedure outlined in the insurance policy–once Brent submitted the formal request for coverage on March 2, 2006.
Therefore, this case addresses the point in time at which an insurer’s duty to act in good faith and fair dealing arises.