Michigan Court of Appeals; Docket No. 98077; Published
Judges Cynar, Hood, and Murphy; Unanimous; Per Curiam
Official Michigan Reporter Citation: 175 Mich App 643; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
TOPICAL INDEXING:
Medicare Benefits
CASE SUMMARY:
In this unanimous per curiam Opinion regarding a matter of first impression, the Court of Appeals affirmed the trial court's grant of summary disposition in favor of plaintiff in a coordinated benefits dispute involving a Medicare Supplemental Policy.
The insured incurred $10,000 of hospital expenses in an automobile accident. He was covered by a no-fault insurance policy issued by Employers Mutual, which contained a coordinated benefits clause. The insured was also covered by a Medicare Supplemental Policy issued by defendant American Community in accordance with MCLA 500.2264a, et seq.
Employers Mutual claimed that American Community was responsible for all medical expenses under the Federal Kemper (Item No. 868) decision. The trial court granted plaintiff’s motion for summary disposition, and defendant appealed claiming that federal law made Medicare secondary to no-fault insurance and, therefore, Federal Kemper was inapplicable to the instant case.
On appeal, the court affirmed the trial court ruling, holding that the Federal Kemper decision was controlling, and where the coordinated benefits provisions of a health insurance policy and a no-fault automobile insurance policy conflict, the health coverage insurer must be primarily liable. The court also noted that Medicare constitutes other health and accident coverage within the meaning of §3109a in accordance with the decisions of Lewis v Transamerica (Item No. 1047) and LeBlanc v State Farm (Item No. 414). The court held that 42 USC 1395y(b)(l) was not applicable. That provision states that if no-fault can reasonably be expected to pay medical costs, then Medicare will not pay those costs. In Michigan, pursuant to the No-Fault Act and the Supreme Court's interpretation in Federal Kemper, no-fault insurance is secondary to other health coverage. Therefore, no-fault cannot reasonably be expected to pay medical costs, and the federal statute was inapplicable.
[Comment: To the extent that the Medicare Supplemental Policy provides for "Medicare Payments," this decision seems to conflict with federal regulations and Michigan Insurance Bureau Bulletin 83-04 (Item No. 674) which exclude auto-accident injuries from "Medicare Payment" when payment can reasonably be expected to be made under an automobile no-fault policy.]
