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Simon v. Priority Health Ins. Co. (COA – UNP 6/18/2020; RB #4096)


Michigan Court of Appeals; Docket #347075; Unpublished
Judges Murray, Jansen, and Markey; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion

Not Applicable

Coordination of Benefits Act (MCL 550.251, Et Seq.)

In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s summary disposition order in which the trial court determined that the plaintiff, Lindsey Simon, was not entitled to a double recovery of her medical expenses from both her health insurer, Priority Health Insurance Company, and the insurer of the motor vehicle that crashed into her while she was a passenger on a motorcycle, Safeco Insurance Company of America.  Simon’s health insurance policy included an exclusionary provision that provided, “[s]ervice or supplies are not covered if you would not be required to pay for them if you did not have this coverage.”  Since Safeco was legally obligated under the no-fault act to pay for Simon’s medical expenses, Priority Health was not obligated to pay for Simon’s medical expenses pursuant to the exclusionary provision.

Simon was injured while traveling as a passenger on a motorcycle.  Simon did not have automobile insurance at the time of the collision, but the vehicle that struck the motorcycle she was traveling on was insured by Safeco.  Initially, Priority Health informed Simon that it was the insurer of highest priority because both the health insurance policy and the Safeco policy had coordination of benefits.  After discovering that Simon was a passenger on the motorcycle at the time of the collision, however, Priority Health determined that Safeco was legally obligated, under the no-fault act, to pay for Simon’s medical expenses.  Pursuant to the aforementioned exclusionary provision in Simon’s policy with Priority Health, then, Priority Health disclaimed any liability for Simon’s collision-related medical treatment.  Simon thereafter filed the underlying action against Priority Health, but the trial court granted summary disposition in Priority Health’s favor.

The Court of Appeals affirmed the trial court’s summary disposition order in favor of Priority Health, noting that Simon had an absolute statutory right to recover PIP benefits from Safeco, and that Priority Health was therefore not obligated to also pay for her medical expenses, pursuant to the exclusionary provision in the policy.

Here, under MCL 500.3114(5)(a), plaintiff had an absolute statutory right to claim and recover PIP benefits from Safeco. Concomitantly, the same statute placed on Safeco the obligation to pay PIP benefits, thereby covering the medical costs incurred in relation to the treatment of plaintiff’s injuries that arose out of the accident. Plaintiff’s entitlement to PIP benefits was a right created purely by statute. Under the exclusionary provision in the health insurance policy, defendant had no obligation to provide any coverage if plaintiff would not be required to pay for healthcare services and supplies absent the coverage. We hold that because Safeco had a statutory obligation to pay PIP benefits to cover the healthcare services and supplies at issue, plaintiff was not required to pay for those services and supplies; therefore, the exclusionary clause was implicated and defendant did not owe any medical benefits to plaintiff under the health insurance policy.

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

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