Michigan Court of Appeals; Docket #296343; Unpublished
Judges Fort Hood, Talbot, and Murray; unanimous: per curiam
Official Michigan Reporter Citation: Not applicable; Link to Opinion 
The Michigan Supreme Court DENIED Leave to Appeal on January 29, 2014; Link to Order
STATUTORY INDEXING:
Coordinated Coverages: Duplicate Recovery [3109a]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this unanimous per curiam opinion, the Court of Appeals affirmed the trial court’s order granting defendant Blue Cross and Blue Shield of Michigan’s motion for summary disposition regarding plaintiff’s claim against Blue Cross to pay the plaintiff medical expenses that the plaintiff had already recovered from defendant AAA of Michigan.
In this case, the plaintiff was injured in a motorcycle accident that involved a motor vehicle and, therefore, was entitled to no-fault benefits. Moreover, there is no dispute that pursuant to MCL 500.3114(5), defendant AAA of Michigan was obligated to pay for plaintiff’s no-fault benefits on an uncoordinated basis. Defendant AAA of Michigan paid these benefits. Plaintiff then filed an action against Blue Cross and Blue Shield of Michigan for it to also issue payment of those medical expenses. Blue Cross and Blue Shield of Michigan filed a motion for summary disposition, pursuant to MCR 2.116(C)(8) and (10), arguing that plaintiff’s breach of contract claim with respect to payment of the medical expenses was foreclosed by the terms of the health insurance contract with plaintiff.
The Court of Appeals ultimately agreed with the trial court that the contract between plaintiff and Blue Cross provided that Blue Cross did not have to pay for expenses that the plaintiff was not legally obligated to pay. Specifically, the Court of Appeals noted that §6.1 of the contract between plaintiff and Blue Cross stated that Blue Cross did not have to pay for care and services, “for which you legally do not have to pay or for which you would not have been charged if you did not have coverage under this certificate.” The court reasoned that at the time when the plaintiff filed the complaint, due to the fact that AAA of Michigan had paid for plaintiff’s medical expenses, the plaintiff did not legally have to pay for these expenses and, therefore, under the terms of the contract, Blue Cross and Blue Shield was not obligated to pay these expenses. In this regard, the court specifically held:
“The clause ‘for which you legally do not have to pay’ is written in the present tense. Thus, we look to the factual situation at the time the complaint was filed, and from that we know that plaintiff did not legally have to pay anything. It is undisputed that before the complaint was filed AAA had paid the outstanding medical bills incurred for plaintiff’s treatment. Consequently, when plaintiff sued Blue Cross to enforce the contract, the exclusionary clause applied because plaintiff and Blue Cross contractually agreed that Blue Cross would not pay for services which ‘you [plaintiff] legally do not have to pay.’ This clause is clear and unambiguous, and enforcement of the terms required the trial court to grant Blue Cross’ motion for summary disposition on this issue.”
