Michigan Court of Appeals; Docket No. 126174; Unpublished
Judges Danhof, Doctoroff, and Brennan; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
In this unanimous per curiam Opinion, the Court of Appeals reversed and remanded the circuit court grant of Auto Club's motion for summary disposition in an action in which Auto Club sought reimbursement from its insured's employer's self-funded health plan for medical expenses paid by Auto Club arising from an automobile accident.
The insured, Mr. Guetzka, was employed by Pentwater and was seriously injured in an automobile accident Pentwater provides health benefits for its employees and dependents through a "self-funded" health and accident benefit plan. Auto Club paid medical expenses arising from the injury, and then sought reimbursement of those expenses from Pentwater's self-funded employee health benefit plan. The trial court granted Auto Club's motion for summary disposition, apparently finding that the employee health benefit plan was primary with regard to medical expenses.
On appeal, the Court of Appeals held "this case is controlled by Auto Club Insurance Association v Frederick and Herrud Inc (Item No. 1509)" and reversed the trial court's decision, finding that the coordination of benefits provisions of §3109a are preempted by the Employee Retirement Insurance Security Act (ERISA) and, therefore, Auto Club has primary responsibility for these medical expenses.
The court also rejected the argument that the purchase of "stop-loss" insurance transforms a benefit plan into an insurance plan for purpose of ERISA.