Michigan Court of Appeals; Docket No. 153516; Published
Judges Brennan, Corrigan, and R. C. Anderson; Unanimous; Opinion by Judge Brennan
Official Michigan Reporter Citation: 202 Mich App 582; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous published Opinion by Judge Brennan, the Court of Appeals affirmed summary disposition in favor of defendant Health Alliance Plan, holding that where the no-fault insurance applicable to auto accident related injuries was non-coordinated and the health plan was coordinated, the Health Alliance Plan was entitled to reimbursement for medical expenses that it paid arising from a motor vehicle accident.
Kenneth Leja was involved as a.pedestrian in an automobile accident and severely injured. He died from his injuries. Leja was covered both by an automobile no-fault policy and a health insurance policy issued by Health Alliance Plan. Both the no-fault insurance company and Health Alliance Plan paid Leja's medical expenses. Subsequently, action was commenced to determine whether Health Alliance Plan was entitled to reimbursement of those expenses it had paid on the basis of its coordination of benefits provision in his health plan. The trial court granted summary disposition in favor of Health Alliance Plan, holding that it was entitled to reimbursement for medical expenses it paid which had already been paid by the no-fault automobile insurance company.
Since the no-fault insurance policy specifically provided for non-coordinated no-fault benefits, and because the health insurance policy provided for coordination of benefits, the Court of Appeals affirmed the trial court and held that Health Alliance had a right to whatever proceeds that plaintiff might collect that reimburse him for medical expenses paid by Health Alliance. The coordination clause in Health Alliance Plan's policy stated:
Benefits provided for services related to any automobile related injury to the extent there is coverage under any no-fault policy shall be billed to the responsible carrier or program. Where services are provided, Health Alliance Plan is assigned the member's right to seek reimbursement. (emphasis added)
The court stated that the language assigning the member's rights to seek reimbursement was plain and unambiguous and entitled Health Alliance Plan to be reimbursed for those expenses paid by the no-fault carrier.
[Editor's Note: The above case was inadvertently omitted from prior summaries.]
