By Alethia Kasben
Gongwer News Service
The Michigan Assigned Claims Plan, which provides medical coverage for individuals injured in traffic crashes who do not have insurance, is unavailable for those who lawfully opt-out of medical coverage, the Court of Appeals ruled recently.
In a published case dated Thursday, Gary Jack Van Heusen v. Michigan Automobile Insurance Placement Facility (COA Docket No. 373182), the court unanimously ruled that an individual injured in an auto crash but not in the car when the injury occurred, is not permitted to seek benefits from the Assigned Claims Plan.
Judge Daniel Korobkin wrote the decision, which was signed by Judge Michael Riordan and Judge Philip Mariani.
The Assigned Claims Plan operates as an insurer of last resort, with medical benefits available for individuals who are injured in vehicle crashes but where no other insurance policy applies.
In the case decided by the Court of Appeals, Gary Jack Van Heusen, the plaintiff, opted out of personal injury protection medical benefits under the Medicare exemption. He was then in a crash and stepped out of the car to assess damage. During the time out of the vehicle, another car was involved in the accident, pushing a car into Van Heusen and causing extensive injuries.
After seeking benefits from the Assigned Claims Plan, the Michigan Automobile Insurance Placement Facility denied the claims. The insurer responded that since Van Heusen opted out of medical benefits, he did not qualify for coverage.
The decision outlines the complexity of the state’s no-fault laws before coming to the conclusion that a person injured in an auto accident while not in a vehicle cannot claim benefits through the Assigned Claims Plan if they’ve opted out of medical benefits.
The plaintiff argued that the Legislature explicitly excluded opt-outers if they are injured occupants, but was silent on non-occupants. That means the non-occupants can claim coverage, Van Heusen contended.
“Accordingly, all other things being equal, we might ordinarily be inclined to infer, as plaintiff urges us to do, that the Legislature, by omitting from MCL 500.3115 the language that it placed in MCL 500.3114(4), signified an intent to allow nonoccupant opt-outers to claim benefits under the MACP,” Korobkin wrote.
Although the argument carries weight, Korobkin wrote, “it does not carry the day.”
“Plaintiff’s reading of the statute, which would entitle individuals who opted out of medical benefits in exchange for paying a lower premium to then claim benefits through the MACP for which they previously declined coverage, runs counter to the centrality of individual choice enshrined by the 2019 reform legislation. We have also recognized that the 2019 reforms were instituted to ‘control the cost of automobile insurance,’” the decision says. “Holding opt-outers to the coverage limits and exclusions that they have chosen is consistent with this goal.”
Additionally, Korobkin wrote the opt-out provision is only available for those with qualified healthcare coverage.
“And because the MACP remains an insurer of last resort, our decision is likewise consistent with the overall aim of the no-fault statute to ensure that most persons injured in auto accidents have some form of medical coverage for their injuries,” he wrote.
Gongwer News Service
The Michigan Assigned Claims Plan, which provides medical coverage for individuals injured in traffic crashes who do not have insurance, is unavailable for those who lawfully opt-out of medical coverage, the Court of Appeals ruled recently.
In a published case dated Thursday, Gary Jack Van Heusen v. Michigan Automobile Insurance Placement Facility (COA Docket No. 373182), the court unanimously ruled that an individual injured in an auto crash but not in the car when the injury occurred, is not permitted to seek benefits from the Assigned Claims Plan.
Judge Daniel Korobkin wrote the decision, which was signed by Judge Michael Riordan and Judge Philip Mariani.
The Assigned Claims Plan operates as an insurer of last resort, with medical benefits available for individuals who are injured in vehicle crashes but where no other insurance policy applies.
In the case decided by the Court of Appeals, Gary Jack Van Heusen, the plaintiff, opted out of personal injury protection medical benefits under the Medicare exemption. He was then in a crash and stepped out of the car to assess damage. During the time out of the vehicle, another car was involved in the accident, pushing a car into Van Heusen and causing extensive injuries.
After seeking benefits from the Assigned Claims Plan, the Michigan Automobile Insurance Placement Facility denied the claims. The insurer responded that since Van Heusen opted out of medical benefits, he did not qualify for coverage.
The decision outlines the complexity of the state’s no-fault laws before coming to the conclusion that a person injured in an auto accident while not in a vehicle cannot claim benefits through the Assigned Claims Plan if they’ve opted out of medical benefits.
The plaintiff argued that the Legislature explicitly excluded opt-outers if they are injured occupants, but was silent on non-occupants. That means the non-occupants can claim coverage, Van Heusen contended.
“Accordingly, all other things being equal, we might ordinarily be inclined to infer, as plaintiff urges us to do, that the Legislature, by omitting from MCL 500.3115 the language that it placed in MCL 500.3114(4), signified an intent to allow nonoccupant opt-outers to claim benefits under the MACP,” Korobkin wrote.
Although the argument carries weight, Korobkin wrote, “it does not carry the day.”
“Plaintiff’s reading of the statute, which would entitle individuals who opted out of medical benefits in exchange for paying a lower premium to then claim benefits through the MACP for which they previously declined coverage, runs counter to the centrality of individual choice enshrined by the 2019 reform legislation. We have also recognized that the 2019 reforms were instituted to ‘control the cost of automobile insurance,’” the decision says. “Holding opt-outers to the coverage limits and exclusions that they have chosen is consistent with this goal.”
Additionally, Korobkin wrote the opt-out provision is only available for those with qualified healthcare coverage.
“And because the MACP remains an insurer of last resort, our decision is likewise consistent with the overall aim of the no-fault statute to ensure that most persons injured in auto accidents have some form of medical coverage for their injuries,” he wrote.
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