American Medical Security, Inc. v. Auto Club Insurance Association of Michigan

238 F.3d 743, 25 Employee Benefits Cas. (BNA) 1705, 2001 U.S. App. LEXIS 36
CourtCourt of Appeals for the Sixth Circuit
DecidedJanuary 4, 2001
Docket98-1973, 99-2110
StatusPublished
Cited by9 cases

This text of 238 F.3d 743 (American Medical Security, Inc. v. Auto Club Insurance Association of Michigan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
American Medical Security, Inc. v. Auto Club Insurance Association of Michigan, 238 F.3d 743, 25 Employee Benefits Cas. (BNA) 1705, 2001 U.S. App. LEXIS 36 (6th Cir. 2001).

Opinion

OPINION

CLAY, Circuit Judge.

This is a consolidated appeal wherein Plaintiff, American Medical Security Inc. (“AMS”), appeals from two separate judgments entered by the United States District Court for the Eastern District of Michigan granting summary judgment to Defendant, Auto Club Insurance Association of Michigan (“AAA”), while denying summary judgment to Plaintiff, regarding Plaintiffs claims involving payment of benefits.

Specifically, in Case No. 98-1973, Plaintiff appeals from the district court’s judgment entered on August 4, 1998, granting summary judgment to Defendant as to the claims for reimbursement pursued by Plaintiff as subrogee to Peter C. Coan and Jerry Williamson. The district court found that as a matter of law, Plaintiffs suit was time barred by the “one-year back” rule under Michigan’s No Fault Insurance Act, Mich. Comp. Laws Ann. § 500.3145. In Case No. 99-2110, Plaintiff appeals from the district court’s judgment entered on September 9, 1999, granting summary judgment to Defendant as to the claim for reimbursement pursued by Plaintiff as subrogee to Andrea Teagan. The district court found that the relevant Michigan statute was not preempted by the Employment Retirement Income Security Act (“ERISA”), 29 U.S.C. § 1144(a); that Michigan’s No Fault Act therefore applied; and that under Michigan’s “Federal Kem-per ” rule, Plaintiff was the primary insurer.

*746 By order of this Court, the two cases, which were heard before the same district judge, were consolidated on appeal, and we now AFFIRM the district court’s judgment in both cases. We have jurisdiction over the matter pursuant to 28 U.S.C. § 1331, inasmuch as Plaintiffs claims arose under 29 U.S.C. § 1132(a)(1)(B) of ERISA.

BACKGROUND

This’Case involves a dispute over which of two potential insurance providers-Plaintiff, American Medical Security, Inc., which is the third-party administrator of ERISA-governed employee welfare benefit plans; or Defendant, Automobile Club Insurance Association, which is a Michigan no-fault automobile insurer-is responsible for the payment of medical expenses paid on behalf of three individuals for injuries that they received when each was involved in separate automobile accidents. The facts relevant to each case are as follows.

A. Case No. 98-1973

On April 26, 1992, Peter C. Coan was injured in an automobile accident. At the time of the accident, Coan was employed by Daniels Glass Co., Inc., and was a participant in its employee benefit plan. Plaintiff, the third-party administrator of the plan, paid out $197,857.85 for medical expenses Coan incurred as a result of the automobile accident.

On April 13, 1993, Jerry Williamson was injured in an automobile accident. At the time of the accident, Williamson worked for C & M Masonry and was a participant in its employee benefit plan. Plaintiff was the third party administrator of the plan and paid out $8,239.38 for medical expenses that Williamson incurred as a result of the accident.

At the time of the accidents, Coan and Williamson each had a valid policy of no-fault insurance with Defendant AAA that included a provision for coordinated coverage. The provision provided as follows:

If the Declaration Certificate shows “COORDINATED MEDICAL BENEFITS,” it is agreed that all other medical insurance or health care benefit plans available to you ... are your primary source of protection.

(J.A. at 409, 435.) The subject Certificates of Group Insurance administered by Plaintiff AMS provide excess coverage as follows:

EXCESS COVERAGE
No benefits are payable for Injury or Sickness for which there is other insurance providing medical payments or medical expense coverage, regardless of whether the other coverage is primary, excess, or contingent. If We make payment on Your behalf, You agree to assign to Us any right You have against the other insurer.

(J.A. at 97,161, 579, 612, 637.)

Plaintiff sought reimbursement from Defendant for the medical expenses that it had paid out on behalf of Coan in a letter dated December 29, 1995. After Defendant orally invoked the “one-year back” rule of Michigan’s No Fault Act, Mich. Comp. Laws Ann. § 500.3145, to deny Plaintiffs request, Plaintiff sent another letter to Defendant dated November 15, 1996, again requesting reimbursement. Thereafter, in a letter dated February 26, 1997, Defendant reiterated its earlier denial of Plaintiffs request once again citing the “one-year back” rule as the basis for doing so.

As a result of Defendant’s denial of Plaintiffs requests for reimbursement, Plaintiff filed suit against Defendant on November 12, 1997, in the United States District Court for the Eastern District of Michigan. On April 27, 1998, Plaintiff filed a motion for summary judgment; on May 27, 1998, Defendant filed an answer to Plaintiffs motion for summary judgment in the nature of a cross-motion for summary judgment. Thereafter, on August 4, 1998, the district court issued a Memorandum and Order wherein the court concluded that the “one-year back” rule was appli *747 cable based upon the Michigan Supreme Court’s decision in Auto Club Insurance Association v. New York Life Ins. Co., 440 Mich. 126, 485 N.W.2d 695 (Mich.1992). Accordingly, the court denied Plaintiffs motion for summary judgment while granting Defendant’s cross-motion for summary judgment. The court opined in relevant part as follows:

The logical extension of New York Life is that (1) when AMS [Plaintiff] sued AAA [Defendant] for reimbursement, arguing that it was secondarily liable, it essentially asserted subrogation; (2) AMS is therefore subrogated to the claims of Coan and Williamson; and (3) AMS must therefore abide by the one-year back rule, which limits Coan and Williamson’s right to recovery. Because AMS sought reimbursement more than one year after the most recent allowable expenses, it cannot now bring these claims against AAA.

(J.A. at 471.)

B. Case No. 99-2110

On July 8, 1994, Andrea Teagan was injured in an automobile accident. Andrea is the daughter of Lillian Tull and, at the time of her accident, Andrea was covered under her mother’s employee benefit plan sponsored by Temp West, Inc. Plaintiff was the third-party administrator of the plan.

Effective May 25, 1992, and through the date of the accident, Defendant insured Tull under an automobile policy which provided coordinated no-fault medical coverage to Tull and Andrea. Shortly after the July 8, 1994, accident, Tull informed Defendant that Andrea was covered by Tull’s ERISA health insurance plan administered by Plaintiff. On July 22, 1994, Defendant verified with Plaintiff that Tull’s health insurance was in effect and covered Andrea.

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238 F.3d 743, 25 Employee Benefits Cas. (BNA) 1705, 2001 U.S. App. LEXIS 36, Counsel Stack Legal Research, https://law.counselstack.com/opinion/american-medical-security-inc-v-auto-club-insurance-association-of-ca6-2001.