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Medical Payments (medpay) is a coverage that may be available under your own auto insurance policy. This coverage will pay for reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by auto accidents and sustained by an insured. It is usually issued in amounts of $1,000, $2,000, $5,000 or even higher. Individuals covered include:

  1. You or any family member while occupying any automobile, or as a pedestrian when struck by a motor vehicle; or
  2. Any other person while occupying your covered automobile or any vehicle driven by you or a family member.

The services are only reasonable and necessary if the treatment is rendered by a licensed medical provider within his practices and the charges are consistent with the usual charges within the geographical area for similar services. Medpay does not cover pain and suffering, scarring, permanent disability or lost wages.

This coverage applies only in limited circumstances. First you must have been injured in the vehicle accident and you must have incurred medical expenses. The insurance coverage does not pay for future medical expenses; it only reimburses for medical expenses you have due to your injuries in the accident. Secondly, you must be an insured under the policy to receive the benefits of med pay coverage. An insured under the insurance policy is:

  • The named insured on the policy (usually the one who owns the vehicle that is insured)
  • The named insured’s resident spouse
  • Any family member to the named insured which is any person related to you by blood marriage or adoption who is a resident of your household
  • Anyone using the vehicle covered under the named insured’s policy

Insurance coverage follows the vehicle. If you are in a vehicle that has med pay coverage on its policy, you will likely be a covered insured under the med pay coverage of the policy. However, you may be a covered insured for med pay coverage under more than one policy. It is best to consult an attorney to be sure you know which policies may cover you under the medical payments coverage.

As is the case with most insurance policies, there are listed exclusions when the policy does not apply. Here is a list of some of the exclusions:

  1. If you are using the car as a taxi no one will be covered;
  2. If the vehicle you are using was furnished for your regular use it will not be covered;
  3. If you own the vehicle and did not buy med pay coverage on that vehicle you will not be covered;
  4. If your family member owns his own car or uses a car regularly, the family member will not be covered under your policy;
  5. If the injury caused by war, rebellion, etc. there is no coverage;
  6. If you are on a motorized vehicle with fewer than 4 wheels there will be no coverage.

It is not required that you carry med pay coverage in North Carolina. Therefore, the coverage is only a supplemental coverage you can purchase on your policy. Typically the charge for this coverage is small compared to the benefit you can receive if you are ever in a vehicle accident. If you are injured and an insured under the med pay policy, then you are entitled to this benefit regardless of fault. I encourage you to ask your agent about adding this coverage to your policy today.

The use of medpay coverage will not increase your premiums. Your insurance premiums can only be increased if you have a chargeable offense, or are involved in a chargeable accident. You are also entitled to be paid the full amount of your medical expenses (up to the limit of your medpay), not just the balance due after other insurance has paid. For example, if you have health insurance, and it paid 80% of your medical expenses, you could still claim the full amount of your bills for medpay reimbursement, not just the 20% balance owing.

NOTE: if there is more than one medpay benefits policy available, you are only entitled to collect up to the exact amount of the total medical expenses you incurred. You cannot submit the same bills for duplicate payment to more than one insurance company. Here is an example of collecting from two different medpay policies.

EXAMPLE: you were in a wreck as a result of someone else’s negligence. You are making a claim against the at-fault person’s liability insurance company. You have medpay available to you in the amount of $1,000 from your own personal automobile policy. Your son (who also owns a vehicle and has his own insurance) lives with you and that entitles you to collect medpay from his policy as well. His limits are $2,000. After you have finished treatment, your total medical expenses are $2,500.

YOUR POLICY ($1,000): You will submit your medical expenses of $2,500 to your policy and you will get paid $1,000. This will exhaust all of the limits from your policy.
YOUR SON’S POLICY ($2,000): You will submit your medical expenses of $2,500 to your son’s policy. Your son’s insurance company will get a $1,000 credit for the medpay already paid under your policy, leaving them to pay $1,500 of your remaining medical expenses.

There are many other scenarios in addition to the example given above that could apply to you. If in doubt about medpay, give us a call and we will be glad to explain your benefits to you and give you free advice about your medpay claim.

Read here for more information on how to file your own medpay claim.

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