Michigan Court of Appeals; Docket No. 132123; Published
Judges Shepherd, Connor, and Sapala; Unanimous; Per Curiam
Official Michigan Reporter Citation: 196 Mich App 283; Link to Opinion
In this unanimous per curiam Opinion, the Court of Appeals affirmed the trial court determination which held that plaintiff was not entitled to recover duplicative medical expenses from plaintiff’s' coordinated health plan, where plaintiff’s had already obtained payment of the same expenses from a non-coordinated automobile insurance policy.
Plaintiff’s were injured in an automobile accident and received medical expense payments pursuant to an automobile policy which did not contain a coordination of benefits provision. Plaintiff’s sought to obtain a "double recovery" of the same medical expenses from defendant, Butterworth HMO. Butterworth HMO had in its contract a coordination of benefits clause providing for both coordination of benefits and non-duplication of benefits.
Plaintiff’s argued on appeal that the trial court erred in granting summary disposition to Butterworth HMO and affirming the coordination and non-duplication provisions of the HMO certificate. Plaintiff’s argued that the coordination of benefits provision in defendant's HMO contract was invalid under the "coordination of benefits act," MCLA 550.251. Plaintiff’s claimed that the provisions of MCLA 550.253(2) prohibits the coordination of benefits provision relied upon by Butterworth HMO. That statute provides:
"Any such policy or certificate which contains a coordination of benefits provision shall provide that benefits under the policy or certificate shall not be reduced or otherwise limited because of the existence of another non-group contract which is issued as a hospital indemnity, surgical indemnity, specified disease, or other policy of disability insurance...”
Plaintiff’s argued that a no-fault automobile insurance policy falls within the definition of a "policy of disability insurance," and therefore, the coordination of benefits provision in the HMO contract was invalid pursuant to MCLA 550.253(2). Defendant Butterworth HMO contended that MCLA 500.3601 establishes that defendant's certificate of coverage is a "group disability insurance policy" which is specifically authorized to provide for the coordination of benefits with automobile medical payments insurance.
In determining which of the two competing statutory provisions applied, the Court of Appeals relied upon the decision in Estabrook v Lincoln National Life Insurance Company, 172 Mich App 450 (1988), in which the court held that MCLA 500.253(2) did not bar coordination with a no-fault policy because the Legislature enacted the coordination of benefits act contingent upon the enactment of MCLA 500.3610a. That panel believed it was clear that the Legislature intended MCLA 500.3610a to control the coordination of group disability policies with non-group no-fault policies, notwithstanding the more general provisions of the coordination of benefits act.
The Court of Appeals held that defendant Butterworth HMO's plan qualified as disability insurance and therefore affirmed the trial court's determination that under the authority of MCLA 500.3610a, the defendant was allowed to coordinate its payment of benefits with no-fault insurance.