Yerkovich v. AAA

610 N.W.2d 542, 461 Mich. 732
CourtMichigan Supreme Court
DecidedApril 25, 2000
Docket112891, Calendar No. 4
StatusPublished
Cited by47 cases

This text of 610 N.W.2d 542 (Yerkovich v. AAA) 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
Yerkovich v. AAA, 610 N.W.2d 542, 461 Mich. 732 (Mich. 2000).

Opinions

Cavanagh, J.

The issues presented are: (1) whether the subrogation agreement between defendant fund and plaintiff Yerkovich entitled the fund to reimbursement from plaintiff for medical expenses and, if so, (2) whether plaintiffs no-fault insurer, defendant AAA, must refund plaintiff for that reimbursement. We hold that the subrogation clause did not confer upon the fund the right to be reimbursed out of plaintiffs third-party recovery from tortfeasors. Because we hold that the fund was not entitled to reimbursement, we do not reach the second question.

[735]*735FACTS

Plaintiffs minor daughter was injured in an automobile accident when the driver of the vehicle in which she was riding negligently collided with another vehicle. At the time of the accident, plaintiff was a participant in the Michigan United Food and Commercial Workers Unions and Food Employers Health and Welfare Fund. The fund is a self-funded employee welfare benefit plan created and administered pursuant to the Employee Retirement Income Security Act (erisa), 29 USC 1001 et seq. Plaintiff also had a no-fault policy issued by defendant AAA.

Plaintiff filed this action on behalf of her daughter against both defendants, seeking payment of medical expenses. The fund had initially denied coverage, claiming plaintiff had failed to execute a subrogation agreement. The fund claimed this was required by the plan’s subrogation clause. Plaintiff eventually signed the “Subrogation Agreement and Assignment” form, and the fund paid $6,832 in medical expense benefits. The AAA also denied coverage, claiming that plaintiff’s policy contained a coordination of benefits clause that made the fund primarily responsible for medical expenses from the accident. Plaintiff also filed a negligence claim seeking noneconomic damages against the driver of the vehicle in which her daughter was riding. That case was settled for $20,000.

Plaintiff and the fund each filed motions for summary disposition in the trial court, essentially advancing the same position. The fund argued that, pursuant to the plan, plaintiff was required to reimburse the fund the $6,832 it had paid for medical expenses out of her third-party tort recovery. Plaintiff and the fund [736]*736agreed that if such reimbursement were required, it would result in plaintiff paying her own medical expenses, contrary to the provisions of the no-fault act. Plaintiff and the fund argued that the AAA should be responsible for paying for the medical expenses. The aaa argued that the language of the subrogation agreement between plaintiff and the fund did not support a right to reimbursement and limited reimbursement to situations where plaintiff recovered medical expenses from a third-party suit. The trial court granted the motions for summary disposition and ordered the AAA to repay plaintiff any sums she paid to reimburse the fund. The Court of Appeals affirmed. 231 Mich App 54; 585 NW2d 318 (1998).

THE SUBROGATION AGREEMENT

At issue in this case is the interpretation of the plan agreement between the fund and plaintiff. Specifically, we must answer whether the fund was entitled to a refund from plaintiff for medical expenses. The fund provided plaintiff with a plan booklet that laid out the rights, benefits, and duties of the parties. Under the “General Provisions” section, the plan provided a subsection entitled “Third Party Subrogation.” The fund argues that, under this section, plaintiff was required to sign further documents ensuring its rights to subrogation, reimbursement, repayment, and assignment. It provides in pertinent part:

This Plan will take advantage of its right to subrogation if you or an eligible dependent are paid benefits by the Plan due to accidental injuries for which someone else may be liable.
Subrogation means that the Plan can recover from the person who caused the injury, or that person’s insurance [737]*737company, the benefits paid on your behalf by the Plan for that injury, including but not limited to . . . tortious conduct by a third party. . . .
. . . [Y]ou or your dependent will have certain responsibilities to the Plan. When you or your eligible dependent submit a claim to this Plan for injuries, the Fund Office will have you complete a form requesting information as to how the injuries occurred and the identity of any potentially responsible third parties. At the request of the Fund Office, you must also sign any other documents and do whatever else is reasonably necessary to secure this Plan’s right of subrogation. You must not do anything to impair or negate this Plan’s right of subrogation; if any of your acts or omissions to act compromise this Plan’s right of subrogation, this Plan will seek reimbursement of all appropriate benefits paid directly to you ....
If you recover lost wages benefits from another source, e.g. from an individual who caused the injury which resulted in your receiving Time Loss Weekly Benefits, the Plan has the right to seek repayment from you .... [Emphasis added.]

Under this plan, the fund declared “subrogation” rights in order to recover from a third party medical expense benefits it paid. In contrast, it declared the right to “repayment” from plaintiff for lost wage benefits it paid in the event that plaintiff recovered the lost wages “from any other source.”

Traditional subrogation is defined by Black’s Law Dictionary (4th ed), p 1595, as “[t]he substitution of one person in the place of another with reference to a lawful claim, demand or right, ... so that he who is substituted succeeds to the rights of the other in relation to the debt or claim, and its rights, remedies, or securities.” As a subrogee, one stands in the shoes of the subrogor and acquires no greater rights than those possessed by the subrogor. Shermer v Merrill, [738]*73833 Mich 284, 287 (1876). In this case, the fund provided its own definition for “subrogation” in the second paragraph of that subsection. It explains that subrogation means the fund may “recover from the person who caused the injury, or that person’s insurance company . . . .” This is consistent with the traditional definition.

Although the agreement provides that the fund may “recover from the person who caused the injury, ” the fund seeks to recover instead from plaintiff. It has done so by arguing that the second agreement signed by plaintiff required plaintiff to repay, reimburse, subrogate, and assign sums and rights to the fund.1 It is agreed that plaintiff signed the second agreement— that greatly expanded her duties under the plan agreement—only after the fund conditioned the payment of medical expenses on her signing the second agreement.

Subrogation Agreement and Assignment
I agree . . . that if the plan advances benefits ... I will repay the plan in full any sums advanced to cover such expenses from any judgement or settlement I or my dependents receive.
I further agree that this promise to reimburse the fund is a lien against and assignment of any such recovery ....
I agree that the fund shall be subrogated in the amount of any sums paid by the fund to my . . . rights of recovery against the third party.

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Bluebook (online)
610 N.W.2d 542, 461 Mich. 732, Counsel Stack Legal Research, https://law.counselstack.com/opinion/yerkovich-v-aaa-mich-2000.