Michigan Court of Appeals; Docket No. 127702; Unpublished
Judges Kelly, Doctoroff, and Neff; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous per curiam Opinion, the Court of Appeals held that a health insurance policy issued by Blue Cross/Blue Shield was ambiguous and therefore Blue Cross/Blue Shield was obligated to pay medical expenses rather than plaintiff’s coordinated no-fault insurer.
In this case, plaintiff’s minor son was severely injured in an automobile accident that occurred on May 24, 1986. Plaintiff’s son was insured under a health care plan provided by Blue Cross. On May 28, 1986, the son was removed as a named insured under the Blue Cross policy which created a cancellation of the Blue Cross coverage effective on June 1, 1986. At the time of the cancellation, plaintiff’s son was a patient in Bronson Hospital. On June 3, 1986, plaintiff’s son was transferred to Mary Free Bed Hospital to receive special care for a closed head injury. Blue Cross paid medical bills only through June 3, 1986 and refused to pay any medical bills incurred at Mary Free Bed Hospital. The policy in question stated that coverage is not provided for services rendered after the termination date "except that the coverage continues for physician and hospital, or skilled nursing facility, or residential substance abuse facility services for continuous predetermined and approved if required in-patient hospital admissions which commenced prior to the termination date of such coverage." Plaintiff argued that the Blue Cross policy could reasonably be interpreted to provide health coverage for continued hospitalization and that the policy does not require that the hospitalization be at the facility. Defendant argued that the policy clearly provides that coverage terminated when there was a change in facility. The court found, "Both interpretations are plausible. Hence, the policy is ambiguous and must be construed in favor of coverage for the insured." The court cited, among other cases, the Supreme Court's decision in Powers v DAIIE (Item No. 979).
