Learn more about Sinas Dramis

Injured? Contact us for a free consultation

   

American Medical Security, Inc. v Allstate Ins Co; (COA-PUB, 4/20/1999; RB #2054)

Print

Michigan Court of Appeals; Docket No. 206239; Published   
Judges Hood, Holbrook, Jr., and Whitbeck; Unanimous; Per Curiam   
Official Michigan Reporter Citation:  235 Mich App 301; Link to Opinion alt   


STATUTORY INDEXING:   
Coordination with Other Health and Accident Medical Insurance [§3109a]   
Coordination with ERISA Plans [§3109a]

TOPICAL INDEXING:   
Employee Retirement Income Security Act (ERISA – 29 USC Section 1001, et seq.)    


CASE SUMMARY:    
In this unanimous per curiam published Opinion, the Court of Appeals held that a non-self-funded ERISA benefit plan was subject to Michigan insurance law and regulation under section 3109a, and as a consequence, as between a coordinated no-fault insurance policy and a coordinated non-self-funded ERISA benefit plan, the non-self-funded ERISA benefit plan was primary for purposes of paying medical expenses to the plaintiff for injuries arising in a motor vehicle accident.  

The insured plaintiff in this case was injured in a motor vehicle accident and incurred medical expenses. He was covered under his mother's employer's benefit plan which the parties agreed was an ERISA plan. However, the plan was not self-funded, but rather, purchased insurance through United Wisconsin to provide for the benefits under the plan. The injured person was also covered under an automobile no-fault policy with Allstate Insurance. Both policies contained coordination of benefits clauses which conflicted.   

American Medical Security, as administrator of the plan, asserted that the federal statute, 29 USC 1001, et seq (ERISA), preempts the Michigan No-Fault Act and Michigan cases which have held that as between conflicting health insurance and no-fault insurance plans with conflicting coordinated benefits provisions, the health insurer is primarily liable for plaintiff’s medical expenses. The Court of Appeals in this case held that under ACIA v Frederick & Herrud, 443 Mich 358 (1993) (Item No. 1628), self-funded plans created pursuant to ERISA must be given their plain meaning despite a conflicting coordination of benefits clause in a no-fault policy.   

Because the ERISA plan at issue was insured, the state may regulate it indirectly through regulation of its insurer and its insurer's insurance contracts. Therefore, section 3109a is not preempted under the circumstances of this case.

Copyright © 2019 Sinas Dramis Law Firm, George Sinas, Stephen Sinas.
All Rights Reserved.
Login (Publishers Only)