U.S. District Court for the Western District of Michigan; Docket No. 1:99-CV-104;
Honorable Robert Holmes Bell; Unpublished
Official Federal Reporter Citation: Not Applicable; Link to Opinion
In this Opinion and Order by Judge Bell, the district court held that a "reimbursement provision" contained in an ERISA funded health insurance plan was enforceable and required plaintiff Dunn to reimburse medical expenses paid by the health insurance plan from Dunn's tort recovery. Judge Bell rejected Dunn's argument that the ERISA plan had breached its fiduciary duty to Dunn and other plan members in failing to make its obligation to pay medical expenses arising from a motor vehicle accident, secondary to any applicable no-fault automobile insurance policy. Judge Bell pointed out that the plaintiff had failed to provide any legal authority supporting his contention that the plan cannot make itself the primary insurer under given circumstances, and Dunn's right to receive benefits is controlled by the language of the plan, not by what is common in the industry.
Judge Bell further pointed out that under the authority of Yerkovich v AAA, 231 Mich App 54 (1998), the Michigan Court of Appeals has held that where an ERISA plan is primarily liable for the payment of medical expenses resulting from an automobile accident, and the plan member is required to reimburse the plan from a tort recovery, the plan member may look to her no-fault insurer to repay any sums she was required to reimburse the plan.
Because the reimbursement issue between Dunn and his no-fault insurer, ACIA, arises under state law, Judge Bell declined to decide whether ACIA should be ordered to repay Dunn for the medical expenses he was obligated to reimburse to his ERISA plan. Dunn's request for relief against ACIA was denied "without prejudice" to Dunn's ability to pursue the issue in state court.