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Coordination of Benefits With Other Available Coverage

Typically, health insurance pays “primary” to no-fault, meaning that the health insurer pays first, and any remaining unpaid accident-related expense should then be paid for by no-fault.  This is called “coordination of benefits”. There are exceptions to this for “ERISA-qualified plans”, discussed below.

Under Michigan law, insurers are required to offer insurance at reduced rates, where that insurance pays secondarily (or is “coordinated”) with health insurance. Uncoordinated coverage provides potentially a more generous stream of coverage, and because it does not cost that much more than coordinated coverage, some folks prefer that coverage. Also, where your No-Fault case is covered by someone else’s policy, due to priority issues under MCLA §500.3114 or MCLA §500.3115, those cases are by definition, “uncoordinated”.

This section also governs disability plans. Most commonly, no-fault insurance carriers get to set off from their coverage, the amounts paid by disability coverage.

“ERISA qualified plans” are plans set up under a federal statute called the “Employee Retirement Income & Security Act”, or ERISA. These are self-funded plans, usually set up by large employers, who get tax and other benefits by setting up these plans. Where there is an ERISA-qualified plan, No-Fault will pay primary to health insurance.

How to know whether your plan is an ERISA-qualified plan? There is a website devoted to this, www.freeerisa.com.

NOTE: When Medicaid is the health insurance provider (in the case of lower income folks), or Medicare (usually with persons over 65, and those on Social Security disability), No-Fault pays primary to these programs.

Call me, if you are on Medicare, and find that your Medicare is paying auto accident related expenses that should be paid by No-Fault, or if Medicare is denying coverage, because your No-Fault carrier should be paying. In those cases, there may be a penalty recovery available under the “Medicare Secondary Payer Act”, 42 USC §1395y(b)(2).

You should not be faced with a potential cutoff of your Medicare benefits, as one of my clients recently was, because his no-fault insurance carrier refused to pay their fair share.

Learn more about Michigan No-Fault Insurance Laws & Protections.

I cannot stress enough the importance of cooperating with your insurance company, before you have to hire me as your attorney. If you do have to hire a lawyer, he/she (or I) will be your contact with the insurance company.
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Sometimes, there are potentially more than just one insurance company, who might be responsible to pay your no-fault benefits.  Specific rules, allocating this responsibility are set forth in MCLA §500.3114, in order, more or less as follows:
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While the actual Michigan No-Fault Act does not limit medical benefits by time, or dollar amount, very few claims are actually paid for anything more than a few months.
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