Michigan Court of Appeals; Docket No. 245068; Unpublished
Judges Zahra, Cavanagh, and Cooper; 2-1 opinion; 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In this 2-1 unpublished per curiam opinion, Judge Zahra dissenting, the Court of Appeals held a no-fault insurance company was not entitled to setoff plaintiff’s long-term disability wage loss benefits from plaintiff’s work loss claim, because the disability benefits were being received through plaintiff’s employer’s self-funded plan and, therefore, such benefits did not constitute “other health and accident coverage” subject to coordination under MCL 500.3109a.
The insurance company in this case contended it was entitled to set off the benefits plaintiff was receiving from a self-funded long-term disability plan, which the plaintiff acquired from his employer through a collective bargaining agreement. The insurance company contended that such a setoff was appropriate under §3109a as “other health and accident coverage” subject to coordination pursuant to plaintiff’s policy of insurance.
Citing the Supreme Court decision in LeBlanc v State Farm Mutual Automobile Insurance Company, 410 Mich 173; 301 NW2d 775 (1981), the Court of Appeals held that the word “coverage” is a “word of precise meaning in the insurance industry, and refers to protection afforded by an insurance policy, or the sum of the risks assumed by a policy of insurance.”
The Court of Appeals relied on the previous holding in Spencer v Hartford Accident & Indemnity Company, 179 Mich App 389, 398; 445 NW2d 520 (1989), in which plaintiff had received work loss benefits from his employer through a formal wage continuation plan pursuant to a collective bargaining agreement. Consistent with established precedent, the Court of Appeals agreed with the trial court and concluded that wage continuation benefits are not “other health and accident coverage” within the contemplation of §3109a.
Justice Zahra, in his dissent, argued that the benefit is not paid directly by the employer as it was in Spencer. The long-term disability benefit at issue in the present case is, according to Justice Zahra, exactly the type of benefit subject to coordination under §3109a. He would hold that the Legislature purposely used the broad term “coverage” rather than “insurance” in describing health and accident benefits available to the insured, independent of the no-fault contract.
