United States District Court Eastern District of Michigan; Docket No. 93-CV-74601-DT;
Judge Gerald E. Rosen; Unpublished
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
In this decision by Judge Rosen, the United States District Court held that plaintiff who was injured in an automobile accident was entitled to receive no-fault PIP benefits from her automobile insurance company, Metropolitan, even though that policy was a coordinated policy under §3109a, because plaintiffs health plan was a self-funded ERISA plan which expressly limited its coverage for medical expenses incurred as a result of a car accident.
In this case, plaintiff was injured in a motor vehicle accident on May 7,1992, and initiated a lawsuit to seek payment for various medical expenses she incurred. Her no-fault carrier, Metropolitan, denied coverage and filed a third-party action against plaintiffs employer-provided self-funded ERISA health plan. Plaintiffs employer, Marysville, sought removal of that third-party action to the federal court, and a determination that pursuant to the language of its plan, it was not obligated to provide coverage.
Plaintiffs no-fault carrier argued that coverage for plaintiffs medical expenses should be apportioned on a "pro rata" basis between it and plaintiffs employer. The language of plaintiff s employer's health plan stated that
"Except as required by law, the plan is secondary to any no-fault automobile coverage. It is not intended to reduce the level of coverage that would otherwise be available through a no-fault automobile insurance policy, nor does it intend to be primary in order to reduce the premiums or cost of no-fault automobile coverage."
Judge Rosen addressed the argument by plaintiffs no-fault company that pro rata liability should be imposed upon the ERISA plan, and held that the decision in Auto Owners v Thornapple Valley, Inc., United States Court of Appeals, Sixth Circuit (August 1,1994) had recently rejected the position of Auto Owners that plaintiffs no-fault benefits should be imposed on a pro rata basis. In the United States Sixth Circuit Court of Appeals, the United States District Court opinion (see Item 162S) imposing pro rata liability was reversed. In light of the ruling of the United States Court of Appeals, Sixth Circuit, the language in plaintiffs employer's health plan expressly limiting coverage for medical expenses incurred as a result of a car accident when the participant has no-fault insurance must be enforced.