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Auto Club Insurance Association v Michigan Insurance Bureau and Michigan Chiropractic Society; (COA-UNP, 12/29/1992; RB #1593)

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Michigan Court of Appeals; Docket No. 133952; Unpublished  
Judges Weaver, McDonald, and Neff; Unanimous; Per Curiam  
Official Michigan Reporter Citation:  Not Applicable; Link to Opinion alt   


STATUTORY INDEXING:  
Allowable Expenses for Medical Treatment [§3107(1)(a)] 
Coordination with Other Health and Accident Medical Insurance [§3109a]  
Coordination with HMO and PPO Coverages [§3109a]

TOPICAL INDEXING:   
Not Applicable   


CASE SUMMARY:  
In this per curiam unpublished Opinion, the Court of Appeals affirmed the decision by the Michigan Insurance Bureau whereby it determined that a "Coordinated Medical Benefits" form issued and interpreted by Auto Club Insurance Association was invalid due to ambiguity.  

In this case, Auto Club Insurance Association would not pay for chiropractic services performed on a policyholder if the policyholder had a health maintenance organization that did not provide chiropractic services. The Insurance Bureau determined this practice to be violative of §3107 of the code which requires no-fault insurers to pay "all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person's care, recovery or rehabilitation." The court also held that the form was ambiguous in that it did not give notice to the insured that the policy would not compensate for chiropractic services not covered by an HMO.  

Auto Club appealed withdrawal of approval of its form and the Court of Appeals affirmed the determination that the disputed clause was ambiguous and contradictory.  


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