Michigan Court of Appeals; Docket No. 180161; Unpublished
Judges Doctoroff, Wahls, and Smolenski; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
Health Insurance Liens Regarding Auto Tort Claims [§3116]
TOPICAL INDEXING:
Employee Retirement Income Security Act (ERISA – 29 USC Section 1001, et seq.)
CASE SUMMARY:
In this per curiam unpublished decision, the Court of Appeals held that a health insurer was not entitled to seek reimbursement for benefits from a wrongful death settlement reached pursuant to Ohio law and paid by an automobile insurer, where Ohio law does not permit the recovery of medical expenses in wrongful death actions. The Court of Appeals also found that a coordination of benefits clause contained in a no-fault policy controlled over the health plan's conflicting coordination of benefits clause, where the health plan was not provided pursuant to an ERISA plan.
The case arose out of medical expenses incurred by a Michigan resident injured in an automobile accident that occurred in Ohio. The insured person subsequently died from the automobile accident injuries. The decedent was covered under a health plan issued by Blue Care Network (BCN) and was also covered under a coordinated policy of no-fault automobile insurance issued by Allstate on the vehicle in which she was riding. BCN refused to provide coverage for the medical expenses, citing an exclusion “for any automobile related injury to the extent that benefits are paid or payable under any automobile or no-fault automobile policy." Allstate provided first party no-fault coverage, and filed suit and sought reimbursement from BCN for the amounts it paid.
The decedent's personal representative had previously filed a wrongful death action under Ohio law against the driver of the vehicle causing the accident. That case was settled by payment of the insurance policy limits of $50,000 paid by American States Insurance Company, pursuant to a release confirming that the proceeds represented non-economic loss only. BCN filed a third party complaint in the Allstate action against the estate of its insured, claiming that if it was required to reimburse Allstate, then BCN was entitled to reimbursement from the estate and American's payment to the estate pursuant to a contractual subrogation clause in the BCN plan.
The Court of Appeals affirmed the trial court's grant of summary disposition in favor of the estate and American against BCN as to the claim for reimbursement. The court found that the Ohio wrongful death statute, medical expenses were not recoverable as a matter of law, and since no recovery could have been made for the medical expenses, BCN was not entitled to reimbursement for those amounts out of the wrongful death settlement under its reimbursement clause. In so holding, the court cited Great Lakes v Citizens Insurance Company (Item No. 1536) and §3116 of the no-fault act for the proposition that a health insurer can only seek reimbursement under a subrogation clause where the ton recovery includes medical expenses.
The Court of Appeals also found that BCN was primarily liable for the decedent's medical expenses. Citing the case of Federal Kemper Insurance Company v Health Insurance Administration, Inc, 424 Mich 537 (1986) (Item No. 868), the court found that the coordination of benefits clause found in the Allstate policy controlled over the competing coordination of benefits clause found in the BCN plan. It is important to note, however, the no-fault coordination of benefits clause controlled in this case because the BCN health coverage was not provided pursuant to an ERISA qualifying employment benefit plan. Because Allstate paid the medical expenses for which BCN was primarily liable, Allstate was entitled to obtain reimbursement from BCN pursuant to its rights as a common law subrogee of its insured.
