Michigan Court of Appeals; Docket No. 212270; Unpublished
Judges Gribbs, Hoekstra, and Markey; 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In this unanimous unpublished per curiam Opinion, the Court of Appeals held that where the no-fault insurance company claims that under a coordinated no-fault insurance policy the plaintiff was required to seek benefits or services available under her health insurance policy, the burden of proof is on the defendant insurance company to show that such benefits or services were available to the plaintiff under the policy. Where defendant insurance company failed to submit the required evidence in the proper form (affidavits based on personal knowledge or admissible documentary evidence), summary disposition in favor of AAA was not appropriate.
AAA claimed that under a coordinated no-fault policy, plaintiff was required to seek her benefits and services first from her own health insurance company, in this case, Health Alliance Plan (HAP), pursuant to MCLA 3109a. AAA argued that under Tousignant v Allstate Insurance Company, 444 Mich 301 (1993), where an insured elects to coordinate no-fault and health insurance coverage, the insured is required to "obtain payment and services from the health insurer to the extent of the health coverage available from the health insurer."
In this case, the court stated, "resolution of the question of whether benefits or services were available from the primary health care provider turns on the terms of the provider's contract. This involves a question of fact." The Court of Appeals held that AAA failed to meet its burden of showing that the plaintiff could have obtained treatment for her injuries with her health care provider, i.e., "it was necessary for defendant to show that the disputed medical services were available or covered by HAP. It was the defendant's burden to produce evidence on the terms of HAP's coverage." Since no evidence was submitted regarding the scope of plaintiff s HAP coverage, summary disposition was not appropriate, and therefore, the trial court was reversed.
