United States Sixth Circuit Court of Appeals; Docket No. 88-1851; Published
Judges Ryan, Norris and Turner; Unanimous
Official Federal Reporter Citation: 88-1851; Link to Opinion
In this unanimous Opinion by Judge Ryan, the Sixth Circuit Court of Appeals held that if the Michigan Supreme Court were to rule that an exclusion in an ERISA health insurance plan that totally excluded coverage for any automobile accident injury was unenforceable against the person insured under a coordinated no-fault policy, then such a state court ruling would be preempted by the federal ERISA statute. The court drew a fundamental distinction between ERISA group health plans, which have coordination of benefits clauses that purport to make the health coverage secondary to coordinated no-fault and those ERISA plans which have a total and complete exclusion for any automobile accident injury. The former plans are not preempted by federal law, but the latter would be. Therefore, under the holding in this case, if an ERISA group health insurer writes a total exclusion that denies benefits for any automobile accident injury, that exclusion would be enforceable even though the injured person has coordinated no-fault coverages. However, if the ERISA group health plan contains a coordination type clause that makes the health insurance benefits secondary to other no-fault coverages, then the attempts to subordinate the health coverages will be invalid under current Michigan law as expressed in the decision of Federal Kemper v Health Administration, Inc. (Item No. 897).