Auto Medical Payments: What Does it Cover?

Medical Payments Coverage is listed on the Declarations Page of your auto policy.  Even insurance policies issued through an “assigned risk plan” can include Medical Payments Coverage. It is a coverage which pays for medical treatment and funeral expenses incurred by the insured and any family members resulting from an accident.  This coverage is no-fault.  Because this coverage is no-fault your premium is not raised if a claim is made under the coverage.   It does not cover the other driver or passengers in a crash. That exposure is covered under Auto Liability Coverage. 

Auto Medical Payments Coverage covers the insured and/or family members when occupying a vehicle.  If you are a passenger in someone else’s vehicle, your vehicle’s medical payments coverage applies to your injuries. This is also true for your family members.  It even covers you or any member of your family when struck by a vehicle, as a pedestrian.  Coverage also applies if you are struck by a trailer and when you are getting into or exiting a vehicle. In addition, persons you give permission to drive your vehicle are covered while they are using your vehicle.

Family members are generally defined as a person living in the same household you live in, that are related to you by blood, marriage or adoption. This includes your “ward” or foster child.

When you are carrying passengers in your vehicle, Medical Payments Coverage applies to any injuries or deaths incurred by these passengers, regardless of whether a crash is your fault, or even if they are injured through their own careless manner in getting into or exiting your vehicle.  There is no exclusion for car pool passengers.  If you use your car to provide transportation on a volunteer basis, i.e. for the benefit of persons being driven to cancer treatments, through the American Cancer Society, any injuries they incur in your vehicle are covered under your Medical Payments Coverage.

If you are operating a taxi service for a charge, your passengers are not covered on your Personal Auto Coverage.  In this instance you need to purchase a commercial insurance policy.  There also is no coverage if you should chose to engage in a racing or speed contest with your vehicle.  If you, or a family member, are a passenger on or in a vehicle with less than 4 wheels, Auto Medical Payments Coverage does not apply.

Business use of your vehicle precludes coverage, as do injuries covered by a Workers Compensation Claim.  If expenses will be paid for or can be paid for by any government coverage, they can not be claimed under your Auto Medical Payments Coverage.
Coverage is based on the limits you chose and is generally quite nominal. It applies on a per person basis. Reimbursement is limited to expenses incurred one to three years from the date of the crash or occurrence, depending on the policy.  Expenses claimed under this coverage must be “reasonable” and “necessary” to be considered for payment.  

If there is other Auto Medical Payments Coverage which applies to an injury, your policy will only pay its share.  Its share is the portion that the limits of your policy bear to the total limits of all policies which apply.  Any Medical Payments Coverage extended to a vehicle you do not own, is excess over the Medical Payments Coverage on that vehicle’s policy.  Most policies also have a “duplicate payments provision”.  This means that you can not collect medical payments coverage for the same bills that are covered under your uninsured motorists or underinsured motorist bodily injury claim.

Most policies have a “reimbursement clause” which requires you to pay back your auto insurance carrier if you collect an auto bodily injury settlement from the responsible party’s insurance for the same medical bills. A few policies are excess over any health insurance that you claim against. This means that you must pay back your auto insurance carrier when your health insurance pays for the same bills.

Some types of expenses covered are; medical and surgical and dental treatment, X-rays, prosthetic devices, eyeglasses, hearing aids, ambulance, hospital, nursing and funeral costs.  Your policy’s “insuring agreement” gives the specifics of what is covered under your policy.

This discussion is presented to clarify the general provisions of Auto Medical Payments Coverage, not to supersede your policy provisions.  There are variations among policies, so be sure to check the provisions of your policy, for application to a specific situation.

The nice thing about having Medical Payments Coverage on your policy is that there always is some coverage for medical bills attached to insuring your vehicle, and that coverage applies to you and your passengers as well as family members and persons you allow to drive your vehicle.

One more cautionary note; a vehicle that is available for your or a family member’s regular use or is owned by you or any family member, and is not a “covered auto” on your policy, will not have Medical Payments Coverage extended to it.