Pm Group Life Insurance Co. v. Western Growers Assurance Trust, Loma Linda University Medical Center

The next worst thing to having no insurance at all is having two insurance companies cover the same claim. In the absence of consistent coordination of coverage provisions, the two companies can dissipate months, even years, wrangling with one another, while the insured and the provider of the covered services are left holding the bag. This is such a case, involving two ERISA-covered health benefit plans.

Facts

On January 1, 1988, Maria Campos gave birth to a daughter, Elizabeth. The baby was bom over three months premature and spent the first five and a half months of her life in the neo-natal intensive care unit at Loma Linda University Medical Center. The medical expenses incurred during that period total $344,000.

Maria Campos and her husband Jose were covered by the employee benefit plans of their respective employers. Maria’s employer provided medical benefits under a plan administered by Western Growers Assurance Trust (Western); Jose’s employer provided medical benefits under a plan administered by Pacific Mutual Life Insurance Company (PM).

Each plan, standing alone, covers virtually all of the $344,000 expended in saving little Elizabeth’s life. To this much everyone…