What is there to know about medical payments coverage?

Posted in Car Accidents on January 9, 2020

What exactly is medical payments coverage?

Under Georgia law, medical payments (“med pay”) coverage is defined as “any coverage in which the insurer agrees to reimburse the insured and others for reasonable and necessary medical expenses and funeral expenses incurred as a result of bodily injury or death caused by a motor vehicle accident, without regard to the insured’s liability for the accident. Coverage shall be available to the named insured, resident spouse, and any resident relative while occupying the covered motor vehicle, and to any other person legally occupying a covered motor vehicle.”

How do I know if I have med pay coverage?

If you are not sure whether you have med pay coverage or not, the fastest way to check is to look at your automobile insurance policy declarations (the “dec page”). This document is generally available online when you log into your online account with your insurance company and should tell you your med pay limits and premium for this coverage.

Is med pay worth the money?

Med pay coverage is relatively cheap and could come in handy when you are injured in a car accident. For example, if you have health insurance with a high deductible or don’t have one at all, that is where your med pay coverage, if you have one, could be helpful in funding your treatment. You have the option of choosing the exact amount of med pay coverage you want. It could be $1,000, $10,000, or more. It’s totally up to you.

Can I use med pay even if I am at fault for the accident?

One of the good things about med pay coverage is that it covers your treatment regardless of fault. Also, it covers your injuries in non-motor vehicle accidents, such as where you are injured in a pedestrian-car accident. Generally, med pay covers medical expenses incurred within 3 years of the accident, but your insurer could make that period longer. Because med pay is a contractual benefit provided by your insurer, you are required to cooperate with your insurer to get this benefit.

If I am not at fault for the accident and I use my med pay, can my insurance company raise my premium?

O.C.G.A. § 33-9-40 prohibits automobile insurance companies from increasing the premium or cancelling your policy when your involvement in the car accident was not your fault.

If I do not have med pay coverage and the other driver involved in the car accident does, can I use his med pay coverage?

No, med pay coverage is a first-party benefit which means that your insurance company provides you, its insured, this benefit.

Will my insurance company try to get back the money they paid under the med pay coverage?

Depending on the circumstances, your insurer may attempt to get the money they paid under the med pay coverage reimbursed from you or get credit or offset against the total amount they have to pay you as an uninsured/underinsured (UM) carrier as a part of the jury’s verdict after a trial. For example, let’s say that you are injured due to a car crash caused by another driver. Your injuries are very serious, and the amount of the at-fault driver’s liability policy limit isn’t sufficient to cover the entire amount of compensation you are seeking. Your med pay coverage limit is exhausted. Luckily, you have UM coverage under your own auto insurance policy. After negotiations with your insurance company regarding this UM claim fail, you file suit and take it to trial. You win, and the jury awards you a large sum via a general verdict. Your insurer might argue that it is entitled to an offset, and ask the Court’s blessing to pay you the amount of the award minus the amount they already paid you under the med pay coverage. They will probably cite their non-duplication of benefits language in your policy as a basis of their argument.

Questions about med pay?

Med pay coverage is beneficial under many circumstances. However, your insurance company might try to limit these benefits by requesting reimbursement or an offset. If you are injured in a car accident and have this coverage, talk with your personal injury lawyer about this coverage.