It Was Good While It Lasted: Maximization of Primary Health Benefits Not Required in Coordination-of-Benefits Cases

Advance Therapy v Auto-Owners is a “For Publication” opinion, which makes the decision binding law. Previously, arguing that an insured must treat with in-network providers was a common defense in coordination-of-benefits PIP cases. Now, whether a provider is in-network or out-of-network is not an automatic disqualifier for secondary auto payment.

Also, the law never required an insured to maximize health coverage to minimize expenses to an auto carrier. The law only requires an insured to follow the coordination-of-benefits provisions in the auto policy. Therefore, assuming all other requirements are met, treating with a “covered” provider and then seeking payment is enough to trigger payment from the secondary auto carrier where the health carrier does not pay.

 Auto carriers with similar coordination-of-benefits provisions will run into similar situations now that this binding case was decided.

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