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Citizens Insurance Company of America v Toledo Electrical Welfare Fund; (USD-___, 9/30/1998; RB #2027)

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U.S. District Court for the Eastern District of Michigan, Southern Division; Docket No. 97-72989;  
Honorable Denise Page Hood; ___________  
Official Michigan Reporter Citation:  ______; 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 written Opinion, Judge Hood held that an amendment to an ERISA plan setting forth a coordination of benefits provision which would make plan benefits subordinate to a no-fault insurance policy was enforceable as to an injured minor's automobile accident injuries which occurred after the effective date of the amendment.

In this case, the minor was injured on August 22, 1995. She was covered by the group health insurance of her parents through the ERISA plan of defendant Toledo Electrical Welfare Fund. She was also covered by a Michigan no-fault automobile insurance policy issued by Citizens Insurance. Citizens claimed that the ERISA plan was primary because the amendment adding the coordination of benefits provision had not been properly communicated to the plan participants. Further. Citizens claimed that because the ERISA plan in its summary plan description did not expressly disavow or subordinate its coverage to no-fault automobile insurance coverage, the plan is ambiguous and should not be found to be subordinate.

In addressing Citizens' issues, Judge Hood held that the amendment to the plan specifically enacting a coordination of benefits provision which subordinated the plan to benefits available under a group or individual no-fault automobile insurance policy was enacted effective November 30,1994. and was effective as of the date the claim arose. Regarding the failure to communicate the amendment to plan participants, the court held that under 29 USC 1024(b)(1), the plan had 210 days after the end of the plan year to inform participants of the amendment. The accident in this case occurred prior to the 210 day deadline, and as such, the amendment is valid.

The court also found that although the summary plan description (a document used to describe the plan) was silent on the issue of no-fault coverage, the plan was not ambiguous on the issue of coordination of benefits as claimed by the plaintiff Citizens. The plan itself was amended and the actual plan language expressly stated that its coverage was secondary to any no-fault insurance coverage.

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