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Coombs v State Farm Mutual Automobile Insurance Company; (COA-UNP, 8/1/1997; RB #1949)

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Michigan Court of Appeals; Docket No Docket No. 197245; Unpublished  
Judges Doctoroff, MacKenzie, and Griffin; Unanimous; Per Curiam   
Official Michigan Reporter Citation:  Not Applicable; Link to Opinion alt   


STATUTORY INDEXING:   
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]    
Coordination with Other Health and Accident Medical Insurance [§3109a]   
Medicaid Benefits [§3109(1)]

TOPICAL INDEXING:  
Social Welfare Act – Medicaid (MCL 400.1, et seq.)   


CASE SUMMARY:   
In this unanimous unpublished per curiam Opinion, the Court of Appeals refused to require a no-fault insurance company to reimburse a plaintiff for medical expenses that had previously been billed by Medicaid where the providers were not seeking to enforce any unpaid balances against plaintiff. In so holding, the court made several observations. First, the court noted that these expenses had not been "incurred'' by plaintiff because there were no unpaid balances and plaintiff was never billed for any expenses not paid by Medicaid. In this regard, the court also noted that the no-fault insurer had "expressly promised to defend and indemnify plaintiff should Medicaid seek reimbursement from him or should any of the medical providers determine that additional sums are owed. The trial court correctly determined that plaintiff was not owed any sums for medical expenses."  

Second, the court noted that plaintiff was not entitled to recover any Medicaid benefits because no-fault insurance covered his accident and therefore Medicaid payments were made in error. This rendered Medicaid a "subrogee of plaintiff's rights" and entitled Medicaid to seek reimbursement for these amounts. Because plaintiff’s rights were subrogated to Medicaid, plaintiff was not entitled to seek payment for those amounts but can only seek payment for expenses incurred outside of the Medicaid payments. No such "extra" expenses were incurred by plaintiff.   

Third, the court noted that the result in this case might be different if the plaintiff had an uncoordinated no-fault policy. In this regard, the court stated,

"In finding that plaintiff is not entitled to recover for benefits he never paid, we specifically distinguish this case from those where the plaintiffs had uncoordinated no-fault and health insurance policies and were entitled to double recoveries. If there were outstanding bills, we would hold that defendant was required to pay either plaintiff or the medical providers for those amounts. However, where there is nothing owed and plaintiff is protected from future claims, this court will not require the insurer to pay plaintiff for the amounts that were originally billed."  


Michigan auto accident attorney Stephen Sinas is the lead editor of the appellate case summaries published on this site regarding the Michigan auto insurance law. To learn more about how Stephen Sinas and how the Sinas Dramis Law Firm can help you if you have been injured in a Michigan auto accident, visit SinasDramis.com.

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