United States District Court Western District; Docket No G87-712 CA;
Judge Douglas W. Hillman; Unpublished
Official Federal Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this written Opinion, Judge Hillman addressed a dispute between a no-fault insurance carrier (Auto Owners) and a health insurance carrier (State Farm), concerning which insurer is liable for payment of medical expenses arising out of an automobile accident.
The injured party had both a no-fault policy and a health insurance policy in effect on the date of the accident. The health insurance policy contained a catastrophic medical expense rider with an exclusion from coverage for any "injury for which the covered person is entitled to benefits under mandatory motor vehicle or automobile insurance."
The no-fault policy contained a coordination of benefits endorsement which provided that the benefits payable under the policy would be reduced by "any health, disability or automobile medical expense insurance policy."
After the accident, the health insurer paid some of the medical expenses, but thereafter, refused to make additional payments, on the basis of its catastrophic medical expense rider.
Judge Hillman found the Federal Kemper (Item No 868) and the Auto-Owners v Lacks Industries (Item No. 996) to be controlling. In cases where an automobile accident victim's health insurance policy and no-fault automobile insurance policy had conflicting "other insurance" provisions, the health insurer's provision was to be given no effect, and thus, the health insurer was primarily liable.
Judge Hillman rejected the argument by the health insurer that the Federal Kemper, supra, and Auto-Owners v Lacks, supra, cases were not applicable because neither had considered the question regarding the "order in which the policies in question were obtained."
Judge Hillman found this argument to be unconvincing, and held that §3109a was not intended to require no-fault insurers to inquire as to the extent of the potential insured's already existing health and accident coverage. Thus, Judge Hillman rejected the contention by the health insurer that had the no-fault insurer conducted an investigation of the nature of already existing health insurance, it would have discovered State Farm's medical expense rider and would not have issued a policy with a conflicting provision.
Judge Hillman also rejected the argument that the Federal Kemper, supra, and Auto-Owners v Lacks, supra, cases should not be applied retroactively to State Farm's insurance policy which was issued before publication of those decisions.
