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West Michigan Health Care Network v Transamerica Insurance Corp of America; (COA-PUB, 3/9/1988; RB #1147)

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Michigan Court of Appeals; Docket No. 95619; Published  
Judges Beasley, McDonald, and Jourdan; Unanimous; Per Curiam  
Official Michigan Reporter Citation: 167 Mich App 218; Link to Opinion alt   


STATUTORY INDEXING:  
Coordination with Other Health and Accident Medical Insurance [§3109a]  
Coordination with ERISA Plans [§3109a]

TOPICAL INDEXING:
Employee Retirement Income Security Act (ERISA – 29 USC Section 1001, et seq.)   


CASE SUMMARY:  
In this unanimous per curiam Opinion, the Court of Appeals dealt with yet another case concerning conflicting coordination of benefits clauses in a health insurance policy and a no-fault automobile insurance policy. In this case, the Court held that a health maintenance organization (HMO) had primary liability for the insured claimant's medical expenses by reason of the Supreme Court's decision in Federal Kemper v Health Insurance Administration, Inc, 424 Mich 537 (1986); see Item No. 897. The Court of Appeals rejected the argument that an HMO was not a health coverage insurer, ruling that under United States Fidelity and Guaranty v Group Health Plan (Item No. 698), the services offered by an HMO constitute "health and accident coverage” as defined by §3109a.

The Court also rejected the argument that Federal Kemper and §3109a did not apply because ERISA preempted them. The Court noted that the insurance savings clause [29 USC 1144(b)(2)(A)] saves the provisions of §3109a from federal preemption. The Court distinguished State Farm Mutual v Muer (Item No. 951), on the grounds that it involved an uninsured plan which was self-funded by the employer. Since the West Michigan plan was commercially insured, it was not an uninsured plan within the meaning of the State Farm v Muer case. The Court also rejected the argument that an HMO was not health insurance within the meaning of the insurance savings clause of the federal act. Because an HMO transfers risk away from its members, it was held to constitute a form of insurance.


Lansing car accident lawyer Stephen Sinas is the lead editor of the appellate case summaries published on this site regarding the Michigan auto insurance law. To learn more about how Stephen Sinas and how the Sinas Dramis Law Firm can help you if you have been injured in a Michigan auto accident, visit SinasDramis.com.

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