Michigan Court of Appeals; Docket No. 88167; Published
Judges Maher, Sawyer, and Tahvonen; Unanimous; Per Curiam
Official Michigan Reporter Citation: 165 Mich App 485; 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 refused to enforce an ambiguously worded coordination of benefits provision in a group health insurance policy which purported to coordinate with any type of no-fault coverage. The group health insurance was provided to plaintiff as a benefit of her employment with Meijer. The plan was administered by defendant Travelers Insurance Company. The coordination clause in question stated in pertinent part:
"What happens if you are covered under more than one group health plan? If a person covered under this plan is also covered under another group health plan sponsored by another employer or one provided by or through the action of any government including any no-fault basic medical payments all the health benefits on the preceding page will be coordinated to prevent duplicate payment for the expense."
The plaintiff had an uncoordinated no-fault policy that was individually purchased. The Court of Appeals held that the group health insurance could not coordinate with this uncoordinated no-fault coverage for the reason that the language used in the group health plan suggests that it only applies to "coordination with other group health plans." The reference to "any no-fault basic medical payments” seems to suggest that it is only group no-fault health coverage that is affected by the coordination clause. In so holding, the Court specifically referred to the Supreme Court's opinion in Powers v DAlIE (Item No. 979) which recognized three basic rules for construction of insurance policies: first, any ambiguity in a policy of insurance must be strictly construed against the insurer, second, exceptions in an insurance policy to the general liability provided for are to be strictly construed against the insurer, and third, an insurer may not escape liability by taking advantage of a forced construction of the language of a policy.
The Court went on to note that even though the coordination provision specifically refers to "any no-fault basic medical payments," that phrase is not sufficiently precise because "that term does not specifically mention privately purchased automobile insurance. . . .Thus, the ordinary meaning of the term 'no-fault basic medical payments' would appear to be payments obtained under a group plan."
In reaching its conclusion, the Court made an important policy point regarding those individuals who purchase uncoordinated no-fault coverage. If a group health insurance plan can coordinate with such uncoordinated no-fault coverage, then a person purchases nothing by buying an uncoordinated no-fault policy. In this regard, the Court stated:
"Applying the aforementioned principles, we conclude that the coordination provision is unambiguously directed toward other group health insurance policies, not individually purchased automobile insurance. Indeed, we would find it anomalous to conclude that plaintiff, who presumably paid a premium for uncoordinated automobile no-fault coverage, ultimately purchased nothing more than a reduction in the liability of her group health carrier."
