Plaintiff instituted this action to seek reimbursement from defendant for medical expenses paid on behalf of Sandra Moon and incurred as a result of a motor vehicle accident. *304 Plaintiff asserted that defendant’s employee benefit plan included medical benefits subject to coordination under the no-fault act, MCL 500.3109a; MSA 24.13109(1). The trial court held that coordination by plaintiff under the no-fault act was not available 1 because defendant’s plan excluded any benefits for motor vehicle accidents in this case. We affirm.
The parties stipulated the facts in the trial court. Sandra Moon was injured in an automobile accident on November 19, 1988. Her no-fault automobile insurance policy, issued to her father, Harold Moon, contained a valid coordination of benefits provision pursuant to MCL 500.3109a; MSA 24.13109(1). The automobile accident occurred in Michigan while Sandra Moon was a resident of Michigan.
At the time of her accident, Sandra Moon and Harold Moon were both covered under the Rospatch Corporation Employee Benefit Plan, which was administered pursuant to the Employee Retirement Income Security Act of 1974 (erisa), 29 USC 1001 et seq. The Rospatch Corporation Employee Benefit Plan (defendant) contained two separate provisions purporting to exclude the payment of expenses incurred as a result of automobile accidents:
MICHIGAN NO-FAULT EXCLUSION
Benefits are not payable under this Plan for injuries received in an accident involving a car or other motor vehicle._
*305 OUT OF MICHIGAN NO-FAULT EXCLUSION
Benefits will not be paid under this plan for injuries received in an accident involving a car or other motor vehicle which is owned or leased by a covered person or any member of his immediate family or involving any car or other motor vehicle for which there is in effect, or is required to be in effect, any policy of No-Fault insurance. This exclusion is not applicable to expenses not paid by any policy of No-Fault insurance as a result of state required policy deductibles or máximums.
Plaintiff paid the medical expenses incurred by Sandra Moon under its no-fault policy. Defendant reviewed those expenses and determined that if it were required to pay expenses for the injuries, it would pay $13,546.85. The only issue the parties could not resolve was whether defendant had to pay any expenses associated with Sandra Moon’s automobile accident.
On appeal, plaintiff challenges the trial court’s ruling that defendant’s plan provided for the exclusion of benefits for injuries incurred in this case. Plaintiff claims defendant’s plan provided for a coordination of medical benefits, and therefore plaintiff was entitled to seek reimbursement under MCL 500.3109a; MSA 24.13109(1).
The trial court held that, despite the ambiguity in the two different clauses, defendant’s plan excluded benefits in this case and did not provide for coordination with other insurance benefits. The trial court held that defendant’s plan was unambiguous because the Michigan exclusion for no-fault benefits was the only provision that applied.
The seminal case in Michigan regarding coordination of benefits is
Federal Kemper Ins Co, Inc v Health Ins Administration, Inc,
The application of Federal Kemper to this case depends on whether defendant’s plan can be construed as including a provision for the coordination of benefits or for the exclusion of coverage. If defendant’s plan included a "pure” exclusion, then it could not be required to coordinate its benefits with those paid in accordance with the no-fault act.
In
Auto-Owners Ins Co v Autodie Corp Employee Benefít Plan,
Plaintiff contends this case should be distinguished from
Autodie
because defendant’s plan appears to coordinate benefits with no-fault insur
*307
anee benefits for motor vehicle accidents that occur outside the State of Michigan. This arguably is an "escape” exclusion that does not avoid coordination under MCL 500.3109a; MSA 24.13109(1). See
Peerless, supra,
pp 1351, 1354;
Auto-Owners Ins Co v Lacks Industries,
We believe that this "escape” provision is inapplicable and irrelevant in this case because the parties agree that Sandra Moon’s accident occurred in Michigan while she was a resident of Michigan. Generally, exclusions in insurance contracts are to be read independently of one another.
Hawkeye-Security Ins Co v Vector Construction Co,
Defendant also argued below, as an alternative theory, that because it was self-insured, 29 USC 1144(a) preempted the coordination of benefits under the state no-fault insurance act. Defendant conceded through the testimony of its administrator that its plan includes stop-loss insurance coverage, or excess insurance coverage for claims in excess of $50,000. Defendant pays all benefits due claimants under the plan, but defendant can seek reimbursement for those claims that exceed $50,000 as a means of protecting the plan. The trial court held that defendant was not a self-insured plan within the meaning of the erisa because of the excess insurance coverage, and consequently federal law did not preempt the coordination of benefits in this case.
*308
We believe the trial court erred in this portion of its ruling. The panel in
Auto Club Ins Ass’n v Frederick & Herrud, Inc (On Remand),
Affirmed in part and reversed in part.
Notes
The trial court granted summary disposition in this case under MCR 2.116(0(10), ruling that there were no genuine issues of material fact and defendant was entitled to judgment as a matter of law. Under this rule, summary disposition is appropriate only when there is no factual support for a claim. See
SSC Associates Limited Partnership v General Retirement System of the City of Detroit,
In
FMC Corp, supra,
But see
Frankenmuth Mutual Ins Co v Meijer, Inc,