Michigan Supreme Court; Docket No. 81755; Published
Opinion by Justice Levin; 4-3 (dissent by Brickley, Riley, and Boyle)
Official Michigan Reporter Citation: 432 Mich 640; Link to Opinion 
STATUTORY INDEXING:
Standards for Deductibility of State and Federal Governmental Benefits [§3109(1)]
Veterans / Military Benefits [§3109(1)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this 4-3 Opinion written by Justice Levin, the Supreme Court held that the no-fault insurer of a military service man who was injured in a service-related auto accident, is not relieved of responsibility under §3109(1) of the No-Fault Act for payment of medical expenses incurred by the serviceman in a non-military hospital, where the serviceman could have obtained the medical service without charge at a military medical facility. The court expressed its holding in the following manner:
"The No-Fault Act preserves to the injured person a choice of medical service providers. Section 3109(1) does not deprive an injured person, who may be eligible to obtain the service in kind in a military hospital, of such choice of medical service providers. The purpose of §3109(1) is to eliminate duplicative benefits provided or required to be provided under federal or state law and thereby reduce the cost of no-fault automobile insurance. Because of differences in quality and service, medical service provided in kind by a governmental source may not be duplicative of medical service obtainable in the private sector with a no-fault medical expense benefit."
The court went on to say that an insured person does not have the choice of deciding what insurance company will pay benefits. However, that was not the situation in this case. Here the choice involved what medical provider would render the service. The court stated:
"We agree with the Court of Appeals that Morgan did not have the option under the No-
Fault Act of choosing which insurance would pay his medical expense. If federal law
obligated the federal government to pay or reimburse Morgan for the expense of his medical
treatment in a non-military hospital, Citizens was not, by reason of §3109(1), obligated to
do so--….
"The Act speaks of benefits provided or required to be provided under the laws of any state or the federal government, and states that such benefits shall be subtracted from the benefits otherwise payable for the injury. The benefits required to be subtracted are generally dollar amounts. When §3109(1) has heretofore been invoked, the benefits sought to be deducted generally were dollar benefits. Section 3109(1) requires the subtraction of governmental dollar benefits from the dollar amount of no-fault benefits — governmental benefit dollars from no-fault insured dollars. A person injured in an automobile accident is not required under § 3109(1) to avail himself of whatever medical service in kind a governmental source may provide. Governmental medical service may not be comparable in quality and service with the doctor or hospital service at the injured person purchased or may be able to purchase with the no-fault dollar."
In an important passage, the court stated, "The No-Fault Act preserves to injured persons a reasonable choice of hospitals and physicians although this may add to the premium cost of no-fault insurance. The no-fault insurer cannot, in the name of reducing the premium cost, require an injured person to obtain medical service from a particular provider." The court went on to state that an injured person is not required by §3109(1) to obtain authorization from a governmental source before proceeding with medical treatment that the injured person has been advised by his physician is necessary. However, the injured person is obligated to submit a request for payment from the governmental source and provide whatever documentation may reasonably be required. The no-fault insurer has the burden of proving that had the injured person provided such documentation, the benefits would have been paid or payable.
Justice Brickley dissented and was joined by Chief Justice Riley. He argued that like kind governmental benefits are "benefits provided or required to be provided" under §3109(1) of the Act and thus, a no-fault insurer is not obligated to pay for said services where they are obtained in the private sector. Justice Boyle concurred only in the result reached by Justice Brickley.
