Elkins v. Farm Bureau General Insurance Company of Michigan et al

Filing 29

ORDER granting in part and denying in part 21 Motion for Summary Judgment; granting in part and denying in part 22 Motion for Summary Judgment. Signed by District Judge Arthur J. Tarnow. (MLan)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION
JULIE ELKINS,
Case No. 17-13717
Plaintiff,
SENIOR U.S. DISTRICT JUDGE
ARTHUR J. TARNOW

v.
FARM BUREAU GENERAL INSURANCE
COMPANY OF MICHIGAN, ET AL.,

U.S. MAGISTRATE JUDGE
ANTHONY P. PATTI

Defendants.
/
ORDER GRANTING IN PART AND DENYING IN PART PLAINTIFF’S MOTION FOR
SUMMARY JUDGMENT [21] AND GRANTING IN PART AND DENYING IN PART
DEFENDANT FARM BUREAU’S MOTION FOR SUMMARY JUDGMENT [22]
This case is a suit by an insured party against 1) her no-fault automobile
insurance provider, who has refused to pay her medical bills following an accident,
and 2) her ERISA medical coverage plan, who paid her medical bills and now seeks
reimbursement.
FACTUAL AND PROCEDURAL BACKGROUND
Plaintiff Julie Elkins was struck by a drunk driver in a November 18, 2016
motor vehicle accident in Oakland County. She is insured both by her automobile
insurance, Farm Bureau General Insurance of Michigan (“Farm Bureau”), and by
her health insurance. Her health insurance is an ERISA plan provided through her
employer, Sutter Home Winery, and administered by Blue Cross Blue Shield /

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Anthem (“the SHW Plan”). The SHW Plan paid for Plaintiff’s medical treatment
and then requested $23,365.82 as reimbursement from Plaintiff, asserting its
subrogation rights. Plaintiff in turn brought this suit to recover that money, plus an
indeterminate amount of money for other accident-related treatment, from Farm
Bureau. Plaintiff also asks for a declaration that Farm Bureau, as the no-fault
automobile insurer, must pay all past and future liens asserted by the ERISA plan,
in addition to attorney’s fees.
Plaintiff brought her Complaint [Dkt. #1] on November 15, 2017.
Count I seeks declaratory relief that Plaintiff should not be required to
reimburse her medical expenses to the Plan. Subpart (a) of Count I seeks an order
declaring that Farm Bureau must pay any liens asserted by SWH or BCBS. Subpart
(b) asks for a determination that Farm Bureau is first in priority to pay for medical
expenses arising from the accident. Count II is a breach of contract claim against
Farm Bureau arising from Michigan’s no-fault law, specifically MCL 500.3105.
Count III seeks a Declaration of Rights concerning the obligations of the parties to
each other.
Plaintiff brought her Motion for Summary Judgment [21] on April 6, 2018.
Defendant Farm Bureau brought its Motion for Summary Judgment [22] three days
later, on April 9, 2018. On May 9, 2018, the SHW Plan Defendants filed a

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Supplemental Brief [25] advocating for its reimbursement by Farm Bureau. The
motions are fully briefed, and a hearing was held on January 15, 2019.
STANDARD OF REVIEW
Summary judgment is appropriate “if the pleadings, depositions, answers to
interrogatories, and admissions on file, together with the affidavits, if any, show that
there is no genuine issue as to any material fact and that the moving party is entitled
to a judgment as a matter of law.” FED. R. CIV. P. 56(c). The movant bears the
burden of establishing that there are no genuine issues of material fact, which may
be accomplished by demonstrating that the non-movant lacks evidence to support an
essential element of their case. Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986).
The non-movant cannot rest on the pleadings and must show more than “some
metaphysical doubt as to the material facts.” Matsushita Elec. Indus. Co., Ltd., 475
U.S. at 586-87. The non-movant must “go beyond the pleadings and by…affidavits,
or by the ‘depositions, answers to interrogatories, and admissions on file,’ designate
‘specific facts showing that there is a genuine issue for trial.’” Celotex Corp., 477
U.S. at 324 (quoting Rule 56(e)); see also United States v. WRW Corp., 986 F.2d
138, 143 (6th Cir. 1993).

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ANALYSIS
1. Farm Bureau’s No-Fault Insurance Coverage is Primary
As a starting point, the SHW Plan’s coverage is clearly secondary to Farm
Bureau. The SHW Plan’s Benefit Booklet states,
“This Plan shall be secondary in coverage to any medical payments
provision, no-fault automobile insurance policy or personal injury
protection policy regardless of any election made by [the member] to the
contrary. The Plan shall also be secondary to any excess insurance policy,
including, but not limited to, school, and/or athletic policies.”
(Dkt. 21-4).
Though Farm Bureau’s plan also contains a coordination of benefits clause,
“In such a situation involving conflicting coordination of benefits provisions, the
terms of the ERISA plan, including its [Coordination of Benefits] clause, must be
given full effect.” Great-West Life & Annuity Ins. Co. v. Allstate Ins. Co., 202 F.3d
897 (6th Cir. 2000). Farm Bureau is therefore the primary coverage provider for
further expenses Plaintiff incurs as a result of her auto accident.
2. The SHW Plan Has No Valid Lien against Plaintiff
Plaintiff is not liable for the September 29, 2017 lien asserted by its ERISA
Plan. (Dkt. 21-3). The “Subrogation and Reimbursement” Chapter of the Plan
provides that the member must reimburse the plan for any recovery or right to
recovery received by the Plaintiff. (Dkt. 21-4). Such a lien can only be asserted,
however, against a discrete sum of money from an actual recovery. See Montanille

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v. Bd. Of Trs. Of the Nat’l Elevator Indus. Health Ben. Plan, 136 S. Ct. 651 (2016)
(holding that § 502(a)(3) of ERISA precluded an ERISA fiduciary from enforcing a
lien against a member’s general assets). If, in the future, Plaintiff recovers from Farm
Bureau for the funds that the Plan paid, the SHW Plan may have a claim for
reimbursement against Plaintiff. But the SHW Plan cannot invoke a lien against a
recovery that does not exist in order to prod Plaintiff into bringing suit against its
no-fault insurer.
The Plaintiff needs no further relief. Nothing in this order shall be construed
to diminish any right that the SHW Plan has against Farm Bureau as a subrogee of
its member. The SHW Plan must bring its own complaint before it can obtain relief.
CONCLUSION
IT IS ORDERED that Plaintiff’s Motion for Summary Judgment [21] is
GRANTED IN PART AND DENIED IN PART.
IT IS FURTHER ORDERED that Defendant Farm Bureau’s Motion for
Summary Judgment [22] is GRANTED IN PART AND DENIED IN PART. Farm
Bureau must provide primary coverage for expenses arising from Plaintiff’s
November 18, 2016 motor vehicle accident.
IT IS HEREBY DECLARED that as long as she is not in receipt of an
actual recovery arising from the November 18, 2016 motor vehicle accident or

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related treatment, Plaintiff Julie Elkins has no duty to reimburse her ERISA Plan
for expenses paid on her behalf.
SO ORDERED.

Dated: March 14, 2019

s/Arthur J. Tarnow
Arthur J. Tarnow
Senior United States District Judge

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