Allstate Insurance Company v Laborers' Metropolitan Detroit Health Care Fund; (USD-UNP, 10/__/1990; RB #1433)


United States District Court, Eastern District of Michigan; Docket No. 90-CV-70221-DT;   
Opinion by Judge Gerald E. Rosen; Unpublished  
Official Federal Reporter Citation:  Not Applicable; Link to Opinion alt   

Coordination with Other Health and Accident Medical Insurance [§3109a]  
Coordination with ERISA Plans [§3109a]

Employee Retirement Income Security Act (ERISA – 29 USC Section 1001, et seq.)  

In this written Opinion, Judge Rosen held that a group health insurance policy contained a "true exclusion" for auto accident injuries and therefore resulted in the federal preemption of a coordinated no-fault policy issued under §3109a of the Michigan No-Fault Act.  

Had the group health care plan clause in question not been a true exclusion but rather a no-fault coordination clause, federal preemption would not have occurred, and the health plan would have been primary to a coordinated no-fault plan. The health plan clause in question provided in pertinent part:

"No benefits, other than death and accidental death and dismemberment benefits, are payable for... any loss resulting from automobile or vehicular related accidents where Michigan no-fault insurance would normally cover such loss."

In the "general provisions" section of the plan, it states, "The fund excludes coverage for any claims arising out of an auto or other vehicular accident."  

Judge Rosen rejected Allstate's argument that this language was not a true exclusion because it was conditioned on the existence of Michigan no-fault coverage. Judge Rosen held: "Contrary to Allstate's interpretation of this provision, the court finds that the emphasized portion clearly does not condition coverage on the actual existence of no-fault insurance coverage. If this effect were intended, the contract provision would simply have stated, any loss resulting from automobile or vehicular related accidents where Michigan no-fault insurance covers such loss. The plain meaning of the language that actually appears in the contract is that losses 'normally covered by no-fault insurance are not covered by the plan, whether or not a particular employee is actually covered by no-fault insurance." 

Thus, citing the case of Liberty Mutual v Iron Workers (Item No. 1291), Judge Rosen found that the group health plan was a true exclusion which could not be coordinated with no-fault.