Michigan Court of Appeals; Docket No. 104512; Unpublished
Judges Beasley, Sawyer, and Foley; 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, relying upon the Supreme Court's opinion in Federal Kemper v Health Insurance Administration (Item No. 897) a health insurance company was primarily liable for medical expenses vis-a-vis a no-fault coordinated insurer even though the health insurance policy contained a provision making it secondary for any medical expenses exceeding $300 where the expense is covered by no-fault insurance. The Court ruled that this so-called "exclusionary clause" was in reality "an escape type coordination of benefits clause" that cannot be enforced under Federal Kemper where there is a coordinated no-fault policy. The Court said, "an escape clause is one that provides that the insurer has no liability where the risk is covered by other insurance.... Because the provision in American's policy is tied to the existence of no-fault coverage, it is an 'other insurance' provision, notwithstanding its coverage of the first $300."
The Court also rejected the defendant's argument that Federal Kemper intended to limits its decision to non-profit health care corporations. The Court found no such distinction in Federal Kemper.
The decision in this case is consistent with the Court of Appeals decision in the case of Michigan Mutual v American Community (Item No. 1102).
