Murphree
Boston Mutual Insurance v. Murphree
Opinion
Lead Opinion
Silverman, J.
In this case we are asked to decide whether an employee health plan, governed by the Employee Retirement Income and Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001 et seq., may coordinate medical benefits with a participant’s un-derinsured motorist (UIM) coverage. We hold that under the coordination provision at issue here, an employee health plan may not coordinate medical benefits with a participant’s UIM coverage.
I. BACKGROUND
On May 7, 1996, Susan Murphree, a minor, was seriously injured in an automobile collision. She suffered compound fractures of the fibula and tibia, crushed vertebrae, and severe soft tissue damage. Murphree’s injuries required extensive care, including multiple grafts and other reconstructive surgeries, resulting in medical costs of approximately $312,000.
The majority of Murphree’s medical expenses were covered by her father’s employee health plan-The Arizona Health Dimensions Benefit Plan. The Plan’s insurer, Boston Mutual, paid approximately $307,000 of Murphree’s medical costs. Her remaining medical expenses were paid by her auto insurer, Uniguard Insurance Company, whose policy contained $5,000 in first-party, “med-pay” coverage.