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Medical Payments (MedPay) Coverage and How It Works

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Medical Payments (MedPay) Coverage and How It Works

medicalA coverage that nearly all automobile insurance companies offer – at least on policies that are above the bare minimum liability coverages required by law – is medical payments or “med-pay” coverage.  Medical payment coverage is one type of insurance we can purchase that protects us directly if we’re injured in an accident.  It’s also a type of “no-fault” coverage in the sense that it’s available regardless of who may have caused the accident and injuries.  Medical payment coverage can also be available to us – similar to uninsured motorist coverage – in situations where we or our family members may not have even been in the covered vehicle when we were injured.  Medpay is an optional coverage in California, as it is in most states – only a few states require it.

Medpay coverage is most useful for paying medical bills for doctors and other medical providers who may not be on our health insurance plans.  If, for example, an injured person wants to treat with a chiropractor or visit a particular medical specialist who isn’t on the person’s regular health insurance plan, med-pay gives them the flexibility to choose these doctors whom they might otherwise have to pay entirely out of pocket.  Medical payments coverage is also helpful for the co-pays, deductibles, and other out-of-pocket medical expenses that have to be paid even with medical providers who are covered by a regular health insurance plan.

Medical payments insurance is relatively inexpensive compared to coverages, like liability and collision coverage.  For most folks, it is a good deal. It can be very helpful in a personal injury claim by providing additional flexibility as to which providers an injury victim may want to see and as to how those provider’s bills will be paid out of the different auto insurance coverages that may be available to the victim.  This type of coverage is most often seen on automobile insurance policies in amounts from $1,000 to $5,000 in coverage limits. Still, it can also be purchased in larger amounts from $10,000 to $25,000 or even more.  The question of how much coverage to purchase is mostly an economic matter of how much you can afford and how good your personal health insurance plan may be.  But even with an excellent health insurance plan, med-pay coverage can still pay off for you nicely at the bottom line, as we will discuss below. 

How Does Medical Payments Coverage Work?

Medical payments coverage typically will provide payments either to a medical provider or directly to the injury victim who incurred the bill for treatment related to an injury sustained in a car accident.  Different insurance companies will use different policy language to limit or make more specific the uses to which this coverage can be applied – so check your own policy to see what the specific limitations may be.  Some may require that health insurance be used first, while others may subject the charges to a “bill review” that will typically come up with a discounted value that is covered.

Medical payments coverage will be available to each and every person in the covered vehicle – driver and passengers – regardless of whether they are an actual policyholder, a relative, or unrelated.  Additionally, med-pay coverage will typically cover the named insureds on the policy, as well as any “resident relatives” who are injured in motor vehicle accidents while not in the covered vehicle.  This would include being hit by a motor vehicle while a pedestrian or bicyclist, or even as a passenger while in someone else’s vehicle.  Again, your particular policy language may limit this, so it pays to read the policy in detail.

Payments under a med-pay coverage are available for a particular motor vehicle incident up to the limits of the coverage.  If you happen to be injured in different accidents, then most med-pay policies provide the coverage limit for each and every incident — $2,000 for treatment related to the first accident, another $2,000 for treatment related to the second accident, and so on.  Sometimes, if a person is injured in a second accident while still treating for injuries from a first accident, the multiple med-pay coverage claims may become more complicated, and this is one place where an experienced personal injury attorney can certainly be helpful.

How Do I Use My Medical Payments Coverage?

Once you or your attorney has notified your auto insurance company that you were injured in a motor vehicle accident, they will open a med-pay claim for you under which you can submit your medical bills for reimbursement.  Depending upon the insurance company, the adjuster assigned to your med-pay claim may be the same person assigned to any collision coverage property damage claim, uninsured motorist claim, and/or other claims related to the incident that you are pursuing with your insurer.  Or they may assign separate adjusters to each of these.

Your insurance company is entitled to verification of some sort that you were actually injured in a motor vehicle incident, and this is usually accomplished by way of a police traffic collision report for the accident, a written or recorded statement from you, a copy of the medical records describing the relation to the incident, and/or a brief report from your doctor.  After this, submitting itemized charges from the provider to your insurance company will prompt them to issue payment under your med-pay coverage to either you or your doctor, at your direction.

Some auto insurance companies will seek to limit or delay issuance of payments under a med-pay plan by a couple different mechanisms:

  • They may submit the charges for a “billing review” in which the medical provider’s bills are compared with “typical” charges for the services rendered. These “typical” charge rates may or may not have much relationship to actual charge rates in your area – our experience is that they are invariably less than what your provider actually charged.
  • They may require additional paperwork from your medical provider, typically either in the form of more detailed, itemized charges or in the form of a medical report detailing your injuries and their provided services.

In either of these instances, an experienced personal injury attorney can assist in getting the bills reimbursed appropriately and promptly.

An important consideration when using medical payments coverage in a case where either a bodily injury liability claim is being pursued against the responsible driver’s insurance company or an uninsured/underinsured motorist claim is that most med-pay insurers want their money back if they can get it back – when and if you receive compensation for your injuries and medical bills.  When there is a separate bodily injury liability claim against the responsible driver who caused your injuries, your insurance company will maintain the right under your policy to collect from that responsible person any amounts that your insurer may have already paid to you under your own policy.  For amounts paid under a med-pay policy, they will usually do this by requiring you to pay them back out of any eventual settlement funds you may receive from the responsible driver or their insurance company.  There are specific legal rules, however, about when and how much of these funds are required to be paid back, and an experienced personal injury attorney will know how to deal with your med-pay insurer to make sure no more than the legally required amount is returned.

The animated video below explains more about Medpay and how it can help you.

How An Experienced Personal Injury Lawyer Can Help

Likewise, if you end up making an uninsured motorist or underinsured motorist claim under your own insurance policy, your insurer will be entitled to a “credit” against any settlement or arbitration award for your UM/UIM claim for whatever amount they have already paid to you under your med-pay coverage.  An experienced personal injury attorney can also help in this instance by getting this credit waived if you’re not receiving full value compensation (being “made whole”) in your injury claims.

Even if you have to pay back some portion of the med-pay funds out of a settlement, arbitration award, or verdict, it’s usually only a reduced percentage of the total, so using available med-pay coverage is nearly always beneficial at the bottom line.

Additional Resources

For information on more of the coverages you may (or should) have on your automobile insurance policy, check out:

For more on insurance companies and their claim tactics, and how an injury lawyer deals with them, click on the links below:

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