Blue Cross & Blue Shield of Mississippi v. Larson

Carolyn Larson (plaintiff) was a bank employee and a participant in the Pascagoula-Moss Point Bank Employee Medical Expense Reimbursement Trust (trust). Larson was also covered as a dependent under a group plan administered by Blue Cross & Blue Shield of Mississippi, Inc. (Blue Cross) (defendant) through her husband’s employer. The Blue Cross policy contained a coordination-of-benefits (COB) provision applicable to beneficiaries with coverage under more than one plan. The COB clause provided that if the sum of the benefits payable by Blue Cross in the absence of the COB clause and the benefits payable by the other plan in the absence of a similar provision would exceed the reasonable cost of the covered services, reimbursement would be limited to the actual cost of the services. The trust contained an other-insurance clause providing that the trust would not reimburse if a claim was covered under any other employer-sponsored insurance plan, regardless of whether the coverage was attributable to the employment of the spouse or dependent of an enrolled employee. Larson submitted a claim to Blue Cross for reimbursement of medical expenses. Blue Cross denied the claim, arguing that its obligation was secondary and that the trust was primarily liable. The trial court found that the Blue Cross coverage was primary and that the trust had contingent excess liability. The appellate court affirmed, and Blue Cross appealed.