Frequently Asked Questions - What is medical payment coverage or MedPay?
Medical Payments insurance coverage, more frequently simply referred to as MedPay, is a type of insurance coverage that is sometimes contained within motor vehicle (auto) liability insurance policies as well as frequently, but not always, within Commercial General Liability (CGL) insurance policies and Homeowners insurance policies. CGL policies are the types of liability policies that businesses and companies obtain to insure themselves and their property. A Homeowners policy is the type of insurance policy obtained by people who own their homes and want to have it, and themselves, insured in the event that someone is hurt on their property, their home catches fire, etc.. Pretty much any home that has a mortgage on it will have a Homeowners insurance policy on it as most mortgage companies require this coverage to be in effect before they will loan any money (and then issue a mortgage) to someone who wants to use that money to buy a home.
With that background, in the Homeowners and CGL settings, MedPay coverage is used to pay for medical bills incurred in treating injuries that are sustained in some type of accident that occurred on the insured property, which means either inside the home or in its yard ( in a Homeowners claim) or inside a store or business or at least somewhere on its property ( in the CGL setting). When the MedPay coverage is included within an auto insurance policy, it is used to pay for that portion of your auto crash related medical expenses that are Not paid by your auto policy’s Personal Injury Protection (PIP) coverage, which usually occurs as a result of that fact that your PIP coverage only pays for 80% of your crash-related medical bills and your PIP coverage typically maxes out at $10,000.
The key thing to know about MedPay insurance coverage within the Homeowners or CGL type setting is that there is no requirement that you prove that your injuries that required this medical treatment were sustained as a result of the insured party being negligent or at fault. Instead, in order to be entitled to receive MedPay benefits, all you have to prove is that you were injured on their insured’s property (the home/yard of their insured homeowner or inside or outside their insured’s store or business) and that as a result of those injuries, you incurred medical bills that you have already paid or which now need to be paid. This is all you have to prove if you are making a claim for MedPay benefits contained within a commercial general liability insurance policy. You simply obtain copies of your medical records and corresponding medical bills from whatever medical provider that you treated with, any proof of payment if you have already paid them, and then submit those to the CGL insurance company with the request that they pay them or reimburse you for your prior payment of them.
Obviously, for the insurance company to make sure that the medical treatment that you received was as a result of an injury that was incurred on their insured’s property or in a covered auto crash, you need to make sure that when you go to the hospital or to whatever medical provider that you seek treatment from, you both verbally mention to the doctor or other medical provider, and also write down on any patient intake or patient history forms that you may be provided and have to fill out, that you are there to receive treatment for injuries (insert areas of body that were injured ) sustained on (insert date of accident) that occurred at (insert location of accident). If you do not include this type of information, then you may have a difficult time convincing the insurance company that the medical treatment that you received that you are now asking them to pay for was in fact treatment received for injuries that were sustained on their insured's property or in an auto crash that their policy covers.
Be aware that in the homeowner's insurance situation, MedPay benefits are not available to the homeowner herself or to any of her family members. Generally speaking, the homeowner's policy will contain an exclusion that provides that MedPay benefits are not provided to the actual Named Insured or any family member of the insured. Rather, MedPay benefits are simply provided/available to any guests who are on the property, or to any strangers who may visit the property who are not deemed trespassers. Again, to be eligible for MedPay benefits under a homeowner's policy, the person seeking those benefits does not have to prove that the insured did anything negligently or wrong which in turn caused that person to be injured. The only requirement is that the injury that required medical treatment was actually incurred or sustained on the insured property, which in the homeowners type of situation is either inside your home or outside on your lawn or any other part of your insured property/real estate.
When a MedPay claim is submitted in a motor vehicle type of situation, this only comes into play if the insured actually purchases MedPay coverage from his or her auto insurance carrier (insurance company). MedPay coverage is not required under Florida law, it is an optional type of coverage that one can purchase in return for paying an additional premium. So, if it was not selected and paid for by you or whomever is the Named Insured on the policy, then you will not be entitled to receive any MedPay benefits.
As discussed above, the reason that you may want to purchase MedPay coverage under your auto policy, assuming you live in Florida or insure your vehicle under a Florida insurance policy, is that under Florida's No-Fault Law, your auto policy is required to contain Personal Injury Protection (PIP) coverage. However, under Florida law, while this PIP coverage is used to pay for medical bills incurred as a result of medical treatment that you receive to treat injuries sustained in a motor vehicle crash, the percentage of the medical bills that the PIP coverage actually pays is only 80 percent of the "reasonable amount" of medical bills, not 100 percent. There is a 20 percent "co-pay" percentage that you are required to pay that is not covered under or paid by the PIP coverage. The way to make sure that 100 percent of your auto crash related medical bills are paid, at least up to the combined policy limits of your PIP and MedPay coverages, is to purchase optional MedPay coverage from your auto insurance carrier. This MedPay coverage will pay the 20 percent co?pay and will keep paying that co-pay until the amount of your MedPay limits is completely used up, which is also referred to as "exhausted." The amount of MedPay coverage that you can purchase from your auto carrier can vary, but generally it is offered in $1,000.00 increments up to a maximum of approximately $10,000.00 although certain high-end carriers may offer higher limits than that.
Finally, although PIP benefits that are paid out by your auto carrier do not have to be paid back or reimbursed to your auto carrier under almost any circumstance, there are situations in which MedPay benefits that are paid out do have to be reimbursed to your auto carrier. This reimbursement requirement only comes into play if you pursue a personal injury claim against another person or entity that was involved in your car crash and you make a recovery on that personal injury claim. In that event, there are occasions where you will be required to pay back some or all of the MedPay benefits that were paid to you, or on your behalf, by your auto insurance company. This is something that we at Trial Pro deal with on a daily basis so please feel free to contact us if you have any questions or desire our representation of you on any aspect of your auto crash claim.
In a Homeowners or CGL type situation, MedPay benefits do Not have to be paid back, even if you also file a personal injury claim against the insured party (the homeowner or insured store or business) to recover for your injuries and any financial damages you incur that are not covered by any MedPay benefits you may receive. You are Not allowed to “double dip”, which means that the insurance company that insures the homeowner or business that you file a personal injury claim against will receive a “credit” or “setoff” in the amount of MedPay benefits that it previously paid, but that is only fair and is in keeping with the overall philosophy of our state and federal judicial justice system, which is designed to fairly compensate you, not reward you, for injuries and damages you sustain as a result of another’s negligence, fault or wrongdoing. We at Trial Pro adopt and agree with this philosophy as it is truly the backbone of our justice system, but we also want to assure you that when you retain us as your attorneys, we will fight on your behalf to make sure that you recover the full and fair value of your claim.