Muskegon County Circuit Court; Docket No. 85-20399-CK
Judge James M. Graves, Jr.;
Official Michigan Reporter Citation: _____; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
TOPICAL INDEXING:
Private Contract (Meaning and Intent)
CASE SUMMARY:
This written Opinion concerns coordination of benefits between no-fault insurance and group health insurance.
Plaintiff’s decedent died from injuries sustained in an automobile collision while she was riding in an automobile owned by her father's corporation. Defendant Hawkeye was the no-fault carrier on the corporate-owned vehicle. Decedent was also insured under a group health insurance policy issued by defendant American Health & Life Insurance Company to the employer of decedent's mother. There was a third insurance carrier in the case, but the claim involving that carrier was settled before the court ruled.
The American group policy contained a coordination of benefits clause that the court ruled applied only to other group insurance. The court also addressed the Coordination of Benefits Act [MCLA 550.253(2)], which it construed as preventing group health insurers from making their policies secondary to individual insurance, such as no-fault.
Defendant American also asserted the applicability of an exclusion which operates when the insured receives "benefits under any workers' compensation act or similar law." The court held that no-fault auto insurance is not "similar" to workers' compensation, and thus the exclusion did not apply.
The Hawkeye policy contained two coordination of benefits provisions. One provision (attached as a rider to the no-fault endorsement) applied, by its terms, to the named insured and family members of the named insured. Following Allstate v Citizens (Item No. 550), and not Briley v DAIIE (Item No. 813), the court held that since the decedent was not a "family member" of the corporate insured, that coordination of benefits clause did not apply.
However, the court held that a second coordination of benefits clause (contained in the main body of the automobile policy) which provided for prorata liability should there be other applicable insurance was valid and applicable. The court rejected plaintiff’s contentions that this coordination of benefits clause was meant to apply to the liability portion of the policy rather than to the no-fault endorsement; that the provision was void because it was inconsistent with the no-fault act’s scheme of coordination of benefits; and the provision was void because the insured was not given an election between coordinated or uncoordinated benefits. Under this "prorata" provision, the court held that defendant Hawkeye was liable for only 50 percent of decedents medical expenses.
However, having held that the American group health policy was uncoordinated, the court further held that American could not claim the benefit of provisions contained in a no-fault policy to which it was a stranger, and therefore remained liable for 100 percent of decedent's medical expenses. In so ruling, the court declined to follow Doss v Citizens (Item No. 876), which is distinguishable in that it involved coordination between two no-fault policies.
