HAPI was formed in 1977 after passage of enabling legislation by the State of Hawaii. HAPI is an inter-indemnity cooperative, made up of physicians and surgeons practicing in the State of Hawaii. HAPI is modeled after California’s Cooperative of American Physicians/Mutual Protection Trust (CAP/MPT).

The Physicians’ Indemnity Plan (PIP) is the means by which HAPI offers medical malpractice coverage to its members. PIP is owned and controlled by HAPI member doctors. PIP currently has approximately 500 active members.

HAPI is designed so that the member physicians share financial responsibility for the professional liability claims of other members. By sharing this responsibility, the members are able to eliminate many of the costs associated with traditional insurance, such as profit margins, excess overhead and sales commissions. HAPI members pay only for the true cost of their professional liability coverage (such as administration, claim defense, settlements, judgments and reinsurance). The savings are passed on to the membership.

Member physicians are involved in all phases of the organization, ranging from approval of new members, voting on changes in coverage, working on claim's management issues and educational loss prevention initiatives. HAPI’s Organizational Structure consists of a  Board of Trustees, a Peer Review Committee, a  Claims Review Committee, an  Investment Committee and a Marketing Committee. The organization also has a full-time Executive Vice President and support staff that oversee all aspects of the program and the day to day operations.