Lang v Liberty Mut Ins Co (COA – UNP 7/20/2023; RB #4615)
Michigan Court of Appeals; Docket #361792; Unpublished
Judges Patel, Boonstra, and Rick; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEX:
Coordination with Other Health and Accident Medical Insurance [§3109a]
Coordination with ERISA Plans [§3109a]
General/Miscellaneous [§3109a]
TOPICAL INDEX:
Not Applicable
SUMMARY:
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s denial of Defendant Liberty Mutual Insurance Company’s (“Liberty Mutual”) motion for summary disposition—in which it sought dismissal of Plaintiff Xavier Lang’s action for unpaid no-fault PIP benefits—and remanded for entry of an order granting summary disposition in Liberty Mutual’s favor. The Court of Appeals held that Lang failed to present sufficient evidence to create a question of fact as to whether Liberty Mutual was responsible for his claimed medical expenses.
Xavier Lang was injured in a motor vehicle accident, at the time of which he was covered under his parent’s no-fault policy with Liberty Mutual and a Blue Care Network (“BCN”) health insurance policy through his employer. Lang’s parent’s no-fault policy was coordinated with respect to medical expenses, but when Lang’s expenses were not paid, he filed suit against Liberty Mutual, claiming that Liberty Mutual was responsible for said expenses and had unlawfully refused to remit payment. Liberty Mutual eventually moved for summary disposition, arguing that Lang presented no evidence to suggest that he had sought payment of his expenses from BCN before turning to Liberty Mutual, nor any evidence to suggest that he complied with the BCN policy’s provisions concerning treatment received from in- versus out-of-network providers; Lang had not even submitted a copy of the BCN policy. In response, Lang asserted that his BCN policy was a self-funded ERISA plan and attached a single bill from a radiology clinic that showed that BCN was billed for his treatment. Without oral argument on Liberty Mutual’s motion and without explaining its ruling, the trial court denied it.
The Court of Appeals reversed the trial court’s denial of Liberty Mutual’s motion, holding that Lang failed to present sufficient evidence to create a question of fact as to whether Liberty Mutual was responsible for his claimed medical expenses. The Court noted that there was a clear coordination of benefits provision in the Liberty Mutual policy and that Lang neither produced a copy of the BCN policy nor any evidence to establish that it was a self-funded ERISA plan. The Court also noted that Lang presented no evidence to establish that BCN denied his claims despite his compliance with the terms of the policy.
“We first turn to whether the no-fault policy was properly coordinated with plaintiff’s health insurance policy. Defendant specifically challenges plaintiff’s claim that defendant is the party first in priority for administering his PIP benefits claim, and contends that BCN was the primary insurer responsible for covering plaintiff’s healthcare costs. To the contrary, plaintiff argues that whether BCN was the primary insurer responsible for reimbursing him is a question of fact for the jury. Plaintiff suggests that defendant is the primary party responsible for administering his insurance claim, but that it is ultimately for the jury to decide whether this is so.
Plaintiff’s argument is unavailing. Under MCL 500.3109a, a person can elect to coordinate their health-insurance coverage with their no-fault coverage. See MCL 500.3109a(1). The main benefit of choosing a policy with a coordinated benefits provision is lower no-fault insurance premiums. Our Supreme Court has noted, however, that ‘[i]nsureds who coordinate, and thus pay a reduced premium . . . are deemed to have made the health insurer the ‘primary’ insurer respecting injuries in an automobile accident.’ Tousignant v Allstate Ins Co, 444 Mich 301, 307; 506 NW2d 844 (1993) (emphasis added). This Court has similarly opined that ‘[w]hen no-fault coverage and health insurance are coordinated, the health insurer is primarily liable for the insured’s medical expenses.’ Farm Bureau Gen Ins Co v Blue Cross Blue Shield of Mich, 314 Mich App 12, 21; 884 NW2d 853 (2016) (emphasis added). Thus, contrary to plaintiff’s argument, BCN was primarily liable for covering his medical expenses in this case.
The other outstanding issue regarding whether plaintiff’s no-fault plan was properly coordinated under MCL 500.3109a turns on whether plaintiff’s BCN health insurance plan was a self-funded ERISA health insurance plan. Plaintiff argued below that a question of fact existed on this issue. On appeal, defendant argues that it is plaintiff’s responsibility to present evidence to rebut the presumption that the no-fault plan was properly coordinated, including evidence that it was an ERISA plan. We agree. While we can only speculate as to why the trial court denied defendant’s motion for summary disposition, the motion was brought under MCR 2.116(C)(8) and (C)(10). In the process of reviewing the motion for summary disposition, which included a number of exhibits, we presume that the court considered both the pleadings and ‘other evidence submitted by the parties,’ when determining whether to grant summary disposition, as is proper under MCR 2.116(C)(10). Innovation Ventures, 499 Mich at 507.
. . .
Defendant next contends that summary disposition should have been granted because plaintiff failed to present evidence showing that he made reasonable efforts to have his medical expenses covered by his BCN health insurance policy. Aside from the aforementioned burden to rebut a claim made in a motion for summary disposition, a no-fault claimant generally bears the burden ‘to prove that he or she is entitled to his or her claimed benefits[.]’ Shelton v Auto-Owners Ins Co, 318 Mich App 648, 655; 899 NW2d 744 (2017). Moreover, a no-fault claimant ‘also has the burden of establishing that he sought to obtain appropriate services from’ the primary insurer, particularly where the policy at issue contains a coordination of benefits provision. Owens v Auto Club Ins Ass’n, 444 Mich 314, 324; 506 NW2d 850 (1993). . . .
On this point, plaintiff claims that he presented ample evidence to show that he sought to obtain reimbursement for medical expenses from BCN before attempting to obtain PIP benefits from defendant. But the only evidence presented to the trial court when it ruled on the motion for summary disposition was a single bill for MRI services from Northland Radiology, Inc. Plaintiff presented no evidence showing what services BCN covered, whether he took advantage of in- network or out-of-network medical treatment, or any documentation to show that he sought coverage through BCN before pursuing PIP benefits from defendant, such as an EOB or a denial letter. Even plaintiff’s deposition testimony, which discusses his treatment with a physical therapist and a chiropractor, does not contain any information about the names of the doctors or facilities where plaintiff sought treatment.”
