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John W. Smith v Physicians Health Plan, Inc.; (COA-PUB, 11/2/1992; RB #1580)

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Michigan Court of Appeals; Docket No. 129064; Published 
Judges Marilyn Kelly, McDonald, and Allen; Unanimous   
Official Michigan Reporter Citation:  196 Mich App 617; Link to Opinion alt  


STATUTORY INDEXING: 
Coordination with Other Health and Accident Medical Insurance [§3109a]

TOPICAL INDEXING: 
Not Applicable   


CASE SUMMARY:  
In this unanimous published Opinion by Judge McDonald, the Court of Appeals ruled that a plaintiff who purchased uncoordinated no-fault coverage who was also insured under group health insurance through his employment, was entitled to recover medical benefits under both his no-fault policy and his group health insurance plan where the group health insurer did not reduce the insurance premium for the privilege of coordinating with non-coordinated no-fault coverage. The court stated, "defendant urges us to prohibit duplicative recovery when a health insurer coordinates with an uncoordinated no-fault policy. However, defendant fails to convince us that the insured in turn receives any benefit from purchasing uncoordinated no-fault.... The legislature provided an election to those who own motor vehicles and are required to obtain insurance. While we recognize the purposes of §3109a include containing both auto insurance costs and health care costs, and eliminating duplicative recovery, where an insured pays a higher premium, that higher premium commands a corresponding return. We therefore reject defendant's assertion that the no-fault act prohibits duplicative recovery in every instance. A health insurer may not circumvent the insured's right of election, via a coordination clause, thereby making itself secondarily liable to an uncoordinated no-fault policy, without offering the insured a correspondingly lower premium." In this case, facts developed during discovery clearly indicated that the defendant health insurer was unable to show any specific reduction in premium charged for its coverage corresponding to its attempt to coordinate with uncoordinated no-fault automobile insurance. Specifically, during discovery, defendant admitted it made no inquiry of its members regarding whether they have no-fault coverage, did not, in any way, adjust its premiums accordingly for those members Who had paid extra premiums to purchase uncoordinated no-fault.  


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