Learn more about Sinas Dramis

Injured? Contact us for a free consultation

   

Abed v Masalko (COA – UNP 2/21/2019; RB #3850)

Print

Michigan Court of Appeals; Docket # 341786; Unpublished
Judges Murray, Servito, and Shapiro; per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion


STATUTORY INDEXING:
Coordination under ERISA plans
Equal Priority Situations [3114(6)]

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


SUMMARY:
In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s ruling that the coordination of benefits provisions in the plaintiff Ruaa Abed’s (“Abed”) medical insurance policy rendered defendant Allstate the primary payor for 50% of Abed’s allowable expenses, because Abed’s medical insurance policy expressly disavowed up to 50% of allowable expenses if Abed had other coverage.

At the time Abed was involved in an automobile accident, she was covered by a no-fault insurance policy through Allstate, as well as a health insurance benefit plan, administered by Aetna.  The health insurance policy lapsed on August 22, 2016, so Allstate sought partial summary disposition, arguing that the AETNA policy was the primary payor for all allowable expenses up to that date.  The language in the AETNA policy, however, contained an express disavowal of “50% of allowable expenses when the insured has other coverage.”  The trial court, therefore, granted Allstate’s motion in part, and ordered Abed’s claim for allowable expenses up to that date to be set off by 50%.  Allstate then filed a motion for partial reconsideration, arguing that the trial court’s conclusion was legal error, which the trial court denied.

The Court of Appeals agreed with the trial court, holding that in light of the conflict between the no-fault insurance policy and the health insurance policy, the plain-meaning of the health insurance policy must be given full effect.

Paragraph 6 of the Aetna policy, relied upon by the trial court in denying Allstate’s motion, states that “[i]f the preceding rules do not determine the primary plan, the allowable expenses shall be shared equally between the plans meeting the definition of plan under this provision.” “Plan” is defined in the policy as “[a]ny Plan providing benefits or services by reason of health care or treatment, which benefits or services are provided by . . . [m]edical benefits coverage in a group, group-type, and individual automobile ‘no-fault’ and traditional automobile ‘fault’ type contracts.” Thus, as the trial court concluded, the Aetna policy expressly disavows coverage for 50% of allowable expenses if there is a no-fault policy providing coverage. Accordingly, with regard to half of the allowable expenses, there is a conflict between the Aetna policy and the Allstate policy, and the Aetna policy must be given full effect. See Thorn Apple Valley, 31 F3d at 374.

The Court of Appeals also agreed with the trial court that “the issue presented in [Allstate’s] motion for reconsideration was the same as the one presented in the motion for summary disposition.”  The trial court’s ruling was thus affirmed.

Copyright © 2019 Sinas Dramis Law Firm, George Sinas, Stephen Sinas.
All Rights Reserved.
Login (Publishers Only)