ABCs of Insurance Claims: M is for Medical Payments

Med Pay

Welcome to the ABCs of Insurance Claims. Over the next few months, Sherri Walker, Sentinel’s Director of Claims will address an aspect of claims handling for every letter of the alphabet to help provide a better understanding of the claims process.

M is for Medical Payments (Med Pay)

As we’ve discussed before, reading your insurance policy can be like trying to read a foreign language. There are words, phrases, and coverages that may have you scratching your head and Medical Payments, also known as Medical Expense, is likely one of them. While it seems straight forward, this coverage can be tricky. Depending on what type of policy applies, the intended recipient of Medical Payments coverage can vary widely.

Med Pay - Automobile Coverage

In auto coverages, Medical Payments, commonly referred to as “Med Pay” is an optional coverage that results in additional premium. It can be purchased in several different amounts of coverage, typically in increments of $1,000 or $5,000, and covers injuries that occur “in, on or about the covered vehicle”. This is a first-party coverage that will pay reimbursable medical costs for the driver or passengers of the vehicle, regardless of fault, with just a few minor exceptions.

Med Pay may also provide some additional coverage for you if you are injured while in someone else’s vehicle or struck by a car as a pedestrian. It is important to note that if you are in someone else’s vehicle at the time of an accident, their Medical Payments coverage would be primary, and would have to be exhausted before your own would apply. In some states, there are laws referred to as Collateral Source Law. In those states the same medical bills may be filed both under an at fault party’s Bodily Injury coverage as well as your own Medical Payments coverage. So, if you are struck in the rear, you could file the same bills with that driver’s insurance and your own Med Pay coverage if available.

Med Pay - Homeowners Coverage

While Medical Payments coverage in an auto policy is considered a first-party coverage, Medical Payments coverage in a Homeowners policy is a third-party coverage. As the homeowner, you cannot collect on Med Pay for yourself or any other member of your household. Similarly, this coverage does not require the homeowner to be at fault to provide payment, but rather pays in the absence of negligence. For instance, if a guest to your home trips over their own feet while walking up to your porch, Med Pay could cover their incurred medical expenses. Conversely, if they fall on a step that is broken and you’ve failed to repair, that would not be handled as Med Pay, but instead under your personal liability coverage as part of your Homeowners policy.

Med Pay - Commercial General Liability Coverage

In a Commercial General Liability policy, a limit of $5,000 or $10,000 can apply for Medical Payments, again with a resulting premium charge. Med Pay is a third-party coverage, again applying when there is an absence of negligence, but often with some exclusions. This coverage typically excludes coverage for injuries that are sustained when participating in exercise or sports, or any other activity for which an injury could be anticipated. For workplaces, this also typically excludes employees, as their injuries would fall under Workers’ Compensation.

In some professions, Medical Payments would also exclude injury received as part of treatment but will have some alternate coverage. For example, if a dentist is installing a bridge in a patient’s mouth and drops a piece of the bridge that cuts the patient, there would be some coverage for immediate care to clean and close the wound.

What Does Med Pay Cover?

So, what does Med Pay intend to cover? Across all lines of business, this coverage is intended to reimburse medical bills, prescriptions, and other items that are needed to treat for injury: such as bandages, OTC medications, heating pads, and ice packs. It does not cover for lost wages or pain and suffering, as those items are related to liability claims, and would be considered as part of a Bodily Injury claim. Med Pay will also pay for funeral expenses in the worst instances. Any of these expenses are payable up to the policy limit of coverage purchased.

Med Pay

While we hope you never suffer an injury or have one occur on your property, we know that accidents do happen. The professionals at Sentinel are here to make sure you have the best safety net possible, and to provide you with advice, guidance, and counsel along the way. Please contact Sentinel today to learn how to further Safeguard Your Success.

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About The Author

Sherri Walker manages the efforts and deliverables of carrier claims adjusters in addition to completing a wide range of insurance claims analyses as Sentinel’s Director of Claims.

Sherri, who has a wealth of multi-line adjuster experience, brings a strong background in customer satisfaction with the ability to diffuse difficult, and sometimes extremely emotional, situations very smoothly.

The Cripple Creek, VA native began her career with Nationwide Insurance in 2005 where she advanced to a Senior Adjuster role. Prior to joining Sentinel, Sherri spent seven years as a Field Claims Superintendent, handling all aspects of claims for Cincinnati Insurance Companies.