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Allstate Insurance Company v Health Alliance Plan (on remand); (COA-UNP, 1/15/1992; RB #1529)


Michigan Court of Appeals; Docket No.144389; Unpublished  
Judges Holbrook, Jr., McDonald, and Jansen; Unanimous; Per Curiam  
Official Michigan Reporter Citation:  Not Applicable; Link to Opinion alt   

Standards for Deductibility of State and Federal Governmental Benefits [§3109(1)]  
Medicare Benefits [§3109(1)]   
Coordination with Other Health and Accident Medical Insurance [§3109a]

Medicare Benefits   

In this unanimous per curiam Opinion on remand from the Supreme Court (Item No. 1518), the Court of Appeals reversed its earlier decision and found that plaintiff Allstate was not entitled to reimbursement of medical expenses it paid pursuant to its no-fault insurance policy where defendant provided so-called "Medigap" benefits supplementing Medicare.  

In light of the Supreme Court's decision in John Hancock Property & Casualty Insurance Company v Blue Cross and Blue Shield of Michigan, 437 Mich 368 (1991) (Item No. 1492), the Court of Appeals held that its earlier decision that plaintiff Allstate was entitled to reimbursement of benefits paid by it was erroneous.  

The issue in this case concerned whether a health care insurer who provided so-called "Medigap" coverage which provides supplemental insurance to Medicare recipients was primary as between the benefits provided under the policy and benefits provided under a no-fault automobile insurance policy. The Supreme Court in Hancock, supra, held that a health insurer has no liability to an insured for medical expenses arising out of an automobile accident, where the health insurance is limited to supplementing benefits provided by Medicare, since a specific federal statute [42 USC 1395y(b)(1)] provides that Medicare is not payable when the payment of a particular medical expense "has been made or can reasonably be expected to be made under no-fault insurance."  

In light of the Supreme Court holding in Hancock, supra, the Court of Appeals here reversed its earlier decision and held that Allstate (the no-fault insurer) was not entitled to reimbursement of medical expense benefits it paid its insured.  

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