Auto Insurance Policy Med-Pay: What is it?

Most California automobile insurance liability policies include (or offer to include) medical payments coverage, or “med-pay,” for short. Most people aren’t familiar with med-pay coverages, don’t know whether they have this coverage, and don’t know how to open up or engage such coverage, even though they have paid a premium for it. This column will address and explain the concept, and how it applies in auto insurance coverage.

Med-pay coverage does what it sounds like: it covers medical expenses arising from medical treatment needed from injuries incurred during the operation of a motor vehicle. It is a different creature than your liability coverage (that provides protection up to a certain dollar limit for damage claims made against you for which you may be liable). People frequently confuse the two.

Let’s take a garden-variety example of a motor vehicle collision caused by a defendant running a red light. Let’s assume our insured plaintiff suffers a broken leg in the collision, required ambulance transport to the hospital and surgery to treat the fracture. Since the injuries and medical expenses arise from the operation of a motor vehicle, our plaintiff’s med-pay is in play. Let’s further assume our plaintiff has a $25,000 med-pay limit (for which he/she has paid a premium). Her medical expenses in this scenario should be covered under the med-pay provisions of her auto policy, up to that $25,000 policy limit. If a surgery and post-surgery rehab were involved, the med-pay limits would likely be exhausted in this example, and medical billings then would be processed under whatever health insurance coverage the plaintiff had.

Med-pay applies even if one is a passenger in another person’s vehicle, except here the primary med-pay would stem from the policy on the car one is in; once that was exhausted, one could turn to the med-pay of one’s own policy. A person’s med-pay would also apply even if they were a pedestrian struck by a vehicle in a crosswalk; all that matters is that the injuries and need for treatment arise out of the use of a motor vehicle (in this example, that of the defendant driver). Because most motorists are unfamiliar with med-pay and how it works, medical bills are often processed under their health insurance coverage, when they should first go through the individual's med-pay with their own insurance carrier first. Hospitals may have the patient’s health insurance coverage information in their data bank, and just process through that. If that health insurance coverage is through Medi-Cal, it becomes particularly important to straighten that mistake out, since Medi-Cal will not reduce their lien reimbursement request at the end of a case if med-pay existed and was not engaged and exhausted first.

It is essential that med-pay be identified, opened and engaged when a person suffers an injury arising from the use of a motor vehicle. Med-pay is usually relatively cheap to purchase once the insured has a policy of liability coverage in place, and has no co-pay, deductible or share of cost involved. It is therefore better coverage than most private health insurance policies offer, and cheaper for the premium dollar expended. Opening up the med-pay provisions in an auto injury claim is one of the most important things to do first. The attorneys at Janssen Malloy LLP are experienced in evaluating and steering such cases through the appropriate steps to engage all potential coverages and to maximize the client’s recovery. Our lawyers stand ready to assist for you or your family when the need arises.

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