Morgan v. Citizens Insurance Co. of America

442 N.W.2d 626, 432 Mich. 640, 1989 Mich. LEXIS 1415
CourtMichigan Supreme Court
DecidedJuly 18, 1989
Docket81755, (Calendar No. 9)
StatusPublished
Cited by18 cases

This text of 442 N.W.2d 626 (Morgan v. Citizens Insurance Co. of America) is published on Counsel Stack Legal Research, covering Michigan Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Morgan v. Citizens Insurance Co. of America, 442 N.W.2d 626, 432 Mich. 640, 1989 Mich. LEXIS 1415 (Mich. 1989).

Opinions

Levin, J.

The principal question presented is whether plaintiff William Morgan’s no-fault automobile insurer, defendant Citizens Insurance Company of America, is relieved of responsibility under § 3109(1)1 of the no-fault automobile liability act for the payment of medical expenses incurred by Morgan in a nonmilitary hospital if Morgan could have obtained the medical service without charge at a military hospital.

The no-fault act preserves to the injured person a choice of medical service providers. Section 3109(1) does not deprive an injured person, who may be eligible to obtain service in kind in a military hospital, of such choice of medical service providers.

The purpose of § 3109(1) is to eliminate duplicative benefits provided or required to be provided under federal or state law and thereby reduce the cost of no-fault automobile insurance. Because of differences in quality and service, medical service provided in kind by a governmental source may not be duplicative of medical service obtainable in the private sector with the no-fault medical expense benefit.

i

William Morgan was injured in an automobile accident on his way to National Guard training. Citizens is the no-fault insurer. Morgan’s initial medical expenses were paid by the federal govern[644]*644ment because he was on military service when the accident occurred.

Nine months after the accident, Morgan experienced pain, sought treatment at a nonmilitary hospital, and was advised to undergo surgery for a ruptured disc. He did so, and incurred medical expense exceeding $10,000. Morgan sought payment of this expense by Citizens. Citizens refused and Morgan commenced this action. During the pendency of this litigation, he submitted bills for this expense to the National Guard, which denied payment.

The circuit judge granted Citizens’ motion for summary disposition on the basis of § 3109(1) of the no-fault act which requires that benefits provided or required to be provided under the laws of the federal government be subtracted from the benefits otherwise payable by the no-fault insurer.

The judge declared that Morgan did not have the option under the act of obtaining nonemergency medical care in a nonmilitary hospital and seeking payment from a no-fault insurer when the federal government is required by law to provide the medical service at a military hospital. He also said that Morgan failed to show that he used reasonable efforts to obtain repayment from the federal government of the expense he had incurred at a nonmilitary hospital.

The Court of Appeals in affirming observed that in Crowley v DAIIE, 428 Mich 270; 407 NW2d 372 (1987), this Court declared that amounts paid by the federal government for medical care provided a member of the armed forces pursuant to 10 USC 1071 is a benefit provided under the laws of the federal government required under § 3109(1) to be subtracted from no-fault benefits otherwise pay[645]*645able to the injured person.2 The Court also noted Perez v State Farm Mutual Automobile Ins Co, 418 Mich 634; 344 NW2d 773 (1984), where this Court ruled that benefits required to be paid to a worker injured in a motor vehicle accident as workers’ compensation, but which will not be paid because the employer did not have workers’ compensation coverage, are not required under § 3109(1)3 to be subtracted from no-fault work-loss benefits. The Court of Appeals said that in Perez the workers’ compensation benefits "were unavailable to the plaintiffs.”4 The Court of Appeals also found significant this Court’s decision in Gregory v Transamerica Ins Co, 425 Mich 625, 634-636; 391 NW2d 312 (1986), where the Court held that the workers’ compensation disability benefits payable for the full period of disability rather than the lesser amount paid in redemption of the insurer’s liability to pay such benefits should be subtracted from the amount of the no-fault benefits payable to a worker injured in an automobile accident during the course of his employment.

The Court of Appeals interpreted the decisions of this Court as "indicating that a no-fault insurer may offset primary insurance benefits except when injured persons fail to receive benefits through no fault of their own.”5 The Court said that Morgan might have been entitled to medical benefits provided by the military if he had received treatment at a military hospital. He did not have a choice of having nonemergency surgery performed at a nonmilitary hospital and seeking payment by the no-fault insurer. The Court of Appeals declared that [646]*646to allow recovery from Citizens "would defeat the purpose of the setoff provision by allowing plaintiff to choose which insurance would pay for his medical treatment.”6

ii

We agree with the Court of Appeals that Morgan did not have the option under the no-fault act of choosing "which insurance would” pay his medical expense. If federal law obliged the federal government to pay or reimburse Morgan for the expense of his medical treatment in a nonmilitary hospital, Citizens was not, by reason of § 3109(1), obliged to do so.

We do not agree, however, with the Court of Appeals or the circuit judge that Morgan was precluded from seeking payment of expense incurred in a nonmilitary hospital simply because he could have had the surgical procedure performed in a military hospital.

The act speaks of benefits provided or required to be provided under the laws of any state or the federal government, and states that such benefits shall be subtracted from the benefits otherwise payable for the injury.7 The benefits required to be subtracted are generally dollar amounts. When § 3109(1) has heretofore been invoked, the benefits sought to be deducted generally were dollar benefits.8 Section 3109(1) requires the subtraction of [647]*647governmental dollar benefits from the dollar amount of no-fault benefits—governmental benefit dollars from no-fault insurer dollars.

A person injured in an automobile accident is not required under §3109(1) to avail himself of whatever medical service in kind a governmental source may provide.9 Governmental medical service may not be comparable in quality and service with the doctor or hospital service that the injured person purchased or may be able to purchase with the no-fault dollar. Hospitals and doctors are not fungible. There are good hospitals and some that are not, good doctors and some that are not. The Legislature did not intend that however legitimate the injured person’s concern regarding the quality of the governmental service in kind—even if the medicine practiced at the hospital or the doctor is questionable, debatable, or notoriously bad—it is nevertheless a benefit as a matter of law within the meaning of § 3109(1).

The no-fault act preserves to injured persons a [648]*648reasonable choice of hospitals and physicians although this may add to the premium cost of no-fault insurance. The no-fault insurer cannot, in the name of reducing the premium cost, require an injured person to obtain medical service from a particular provider.10

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Cite This Page — Counsel Stack

Bluebook (online)
442 N.W.2d 626, 432 Mich. 640, 1989 Mich. LEXIS 1415, Counsel Stack Legal Research, https://law.counselstack.com/opinion/morgan-v-citizens-insurance-co-of-america-mich-1989.