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Estabrook v Lincoln National Life Insurance Company; (COA-PUB, 10/18/1988; RB #1186)


Michigan Court of Appeals; Docket No. 97728; Published    
Judges Sullivan, MacKenzie, and Schnelz; Unanimous; Per Curiam    
Official Michigan Reporter Citation:  172 Mich App 450; Link to Opinion alt    

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

Coordination of Benefits Act (MCL 550.251, et seq.)    

In this unanimous per curiam Opinion, the Court of Appeals enforced a health insurance coordination of benefits clause that purported to make it secondary to primary, uncoordinated no-fault coverage. The health coordination clause in question stated in relevant part, "Lincoln National does coordinate with individual no-fault automobile insurance policies ... by whatever name called.” The Court rejected plaintiffs argument that this coordination with no-fault was invalid under § 3(2) of the Coordination of Benefits Act [MCLA 550.253(2)] which provides that "any group disability benefit 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... or policy of disability insurance as defined in § 3400.” Even though a no-fault policy is "another non-group contract” the Court held that § 3(2) was superseded by §3610a (MCLA 500.3610a) which provides in relevant part that a group disability insurance policy may contain provisions for the coordination of benefits otherwise payable under the policy with benefits payable for the same loss under other group insurance; automobile medical payments insurance. . . . “Because §3610a applies specifically to automobile medical payments, it controls as opposed to §3(2) of the Coordination of Benefits Act.

The Court also rejected the plaintiff’s argument that the phrase "individual policies" was not restricted to the insured's individual policies but rather referred to any "non-group" no-fault plan.

Therefore, the Court held that the coordination of benefits clause in this particular health insurance policy was sufficiently specific and precise so as to validly effectuate coordination with non-coordinated no-fault coverage.

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