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Flores v. Barretto9/24/2002
ut regard to fault. Tort law, on the other hand, "especially in the field of negligence, is to compensate injured parties for the wrongs of others[.]" Kaileha v. Hayes, 56 Haw. 306, 320, 536 P.2d 568, 576 (1975). Flores asks this court to collaterally estop a defendant from litigating issues of causation and actual damages in the tort context if an arbitrator has rendered a decision in a no-fault arbitration proceeding.
Collateral estoppel has been defined by this court as "an aspect of res judicata which precludes the relitigation of a fact or issue which was previously determined in a prior suit on a different claim between the same parties or their privies." Marsland v. International Soc'y for Krishna Consciousness, 66 Haw. 119, 124, 657 P.2d 1035, 1039 (1983). To successfully establish that AIG was estopped from relitigating issues, Flores had the burden of establishing that:
(1) the issue decided in the prior adjudication is identical to the one presented in the action in question; (2) there is a final judgment on the merits; (3) the issue decided in the prior adjudication was essential to the final judgment; and (4) the party against whom collateral estoppel is asserted was a party or in privity with a party to the prior adjudication. Casumpang v. ILWU, Local 142, 94 Hawaii 330, 338, 13 P.3d 1235, 1243 (2000).
Flores argues that the only issue at the bench trial was Plaintiff's damages. The only item of special damages was Plaintiff's medical expenses. To prove his medical expenses, Plaintiff had to prove that the Defendant caused the injuries, and the medical expenses were appropriate, reasonable, and necessarily incurred. This is the exact same issue Plaintiff had to prove in the arbitration.
Contrary to Flores's argument, the conclusions of the arbitrator did not include a determination of causation and actual damages in the context of tort litigation.
The relevant issues, as identified by the arbitrator, were whether (1) Flores required a treatment plan that would exceed the fee schedule, (2) the recommended treatment was appropriate and reasonable, and (3) AIG's denial of no-fault benefits was correct. The first issue of exceeding the fee schedule is a determination as to whether the extent of the proposed treatment was appropriate; thus, it was incumbent upon the arbitrator to determine if the proposed treatment was appropriate, considering the diagnosis made by the treating chiropractor. The arbitrator must then determine whether the treatment plan recommended by the provider was the optimum treatment for the given diagnosis.
The relevant inquiry is whether a claimant was in a motor vehicle accident compensable through the no-fault program. If the claimant was in a compensable motor vehicle accident, expenditures for medical treatment are expressly provided. See HRS § 431:10C-103(6). Fees in excess of the medical fee schedules are subject to a determination whether the treatment provider "finds that the nature of the injuries and the process of recovery require a treatment plan resulting in fee schedules or treatment guidelines to be exceeded." HRS § 431:10C-308.6. Dr. Basto found that exceeding the fee schedule for Flores's treatment was necessary. The next inquiry, then, is whether the excess is reasonable and necessary.
Flores argues that the arbitrator's determination that the medical expenses were reasonable and necessary is further evidence of identical issues. Flores states that " o prove his medical expenses, had to prove that [Renee] caused the injuries, and the medical expenses were appropriate, reasonable, and necessarily incurred." Whether expenses are reasonable and/or necessarily incurred has no b
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