There are some cases in which a logical resolution of an issue is logically crafted, but does not seem right. Palisades Insurance Company v. Horizon Blue Cross Blue Shield, approved for publication on July 27, 2021, presents such a case, a resolution that is logical but just doesn’t seem right.
It all started with an automobile accident or, rather, four automobile accidents with injuries to occupants requiring medical treatment. Each of the injured persons had elected under their automobile policies to designate their health insurer as the primary insurer responsible to pay for medical care in the event of auto injury. This option became available in 1990 when the No-Fault Act was amended to allow insureds to choose their health insurer as primarily responsible for paying medical expenses arising out of automobile accidents, an option which reduced the insured’s auto policy premiums. Health insurers, in turn, were prohibited from including in their policies any provision which “restricts, limits, or excludes coverage” for expenses arising out of automobile accidents.