Random Thoughts About Automobile Medical Payment Coverage

RANDOM THOUGHTS ABOUT AUTOMOBILE MEDICAL PAYMENT COVERAGE

William “Bill” Hurst, Indiana Personal Injury Lawyer

woman hit by vehicle

When you’re injured in an accident involving a vehicle and you have an automobile casualty policy, the medical payment coverage (“med pay”) of that policy will pay medical bills for injuries resulting from the accident.  A typical medical pay provision of a casualty insurance policy provides that your insurance company will:

“[P]ay the reasonable expenses incurred for necessary medical services received within (3) years from the date of a motor vehicle accident because of bodily injury: (1) Sustained by an insured person; and (2) caused by that motor vehicle accident Most policies also include language which gives the insurance company the right to determine whether the expenses for medical services are reasonable” and “whether the medical services are necessary.” (Indiana Progressive Policy).

These provisions are the often used excuse by the automobile insurance carrier’s to deny payments to medical providers. Please look at your own automobile insurance policy because the time period for repayment of expenses may be anywhere from 1 to 3 years.

Who can make a Claim for Medical Payments?

Each casualty insurance policy is unique in defining the “insured” persons under the policy.  The Progressive policy noted above states:

“Insured person” means: (a) you or a relative: (i) while occupying an auto; or (ii) when struck by a motor vehicle or a trailer while not occupying a self-propelled motorized vehicle; and (b) any person while occupying a covered auto with the permission of you or a relative (Indiana Progressive Policy).

Obviously each carrier’s policy is unique so it is important to carefully read your own. That being said, most policies are similar to the above and provide for medical payments under the policy so long as you are involved in an accident with a motor vehicle.  What this means is that even if you’re in a friend’s vehicle or walking down a sidewalk, so long as you are hit by a “motorist” the policy applies and your injury expenses are reimbursed. Whether one is considered in an automobile can also become a murky issue. In the case of United Farm Bureau Mut. Ins. Co. v. Pierce, 152 Ind. App. 387, 283 N.E.2d 788 (1972), the court found that the insured whose automobile became stuck in the snow and who, while pushing on front fender, slipped, cutting fingers on his left hand, was “upon” his automobile at time of accident and was covered by medical payment provision applicable while insured was occupying vehicle, which was defined as being “in or upon, entering into or alighting from” the automobile. The court went on further to say that “It would further appear that the ‘entering or alighting’ cases required an intent coupled with an overt act necessary to enter or exit the vehicle. Physical support may or may not be a factor to be considered.” United Farm Bureau Mut. Ins. Co. v. Pierce, 152 Ind. App. 387, 390, 283 N.E.2d 788, 790 (1972).

Health Insurance vs Med Pay Coverage

The interplay between your own health insurance (if you happen to have a policy) and the medical payment coverage under your casualty auto policy is one of the issues you must deal with immediately after a vehicular accident involving a personal injury. After you arrive at a hospital the issue of “how” and “who” pays the bills will be important. Specifically, do you pay your medical bills with the auto medical payment coverage or your health policy or both?

I find that most of my clients have medical providers who encourage them to use the medical payment through their auto insurance policy instead of their health insurance. Why is this? It is because health insurance companies have agreements with medical facilities/providers and pay discounted amounts for specified services. In contrast, when using automobile medical payment coverage, the hospital or provider gets the full amount of medical billings.  To maximize your recovery in an automobile accident in Indiana make sure you use your medical insurance first.  Later you still can receive your carrier’s medical payments which can be paid directly to you, the insured, to be used until your case is settled.

Med Pay Coverage When You’re a Passenger in a Friend’s Car

Assume you own an insured vehicle but you are in a friend’s vehicle when an accident occurs and you are injured. The good news is both policies may provide coverage up to their specified dollar limits. The medical coverage on your friend’s vehicle would be considered “primary” and your med pay coverage “secondary”. This means that once your medical bills exhaust the primary policy, your policy will “kick in” and pay up to the limits provided by the policy. You thereby benefit from double coverage!

Do I Have to Repay My Insurance Company for the Medical Benefits When I Settle My Personal Injury Case?

Normally the answer is yes in Indiana; note Indian does not have PIP (Personal Injury Protection) coverage.  Your automobile casualty insurance company is generally “entitled the rights of recovery that the insured person to whom payment was made has against another, to the extent of [the insurance company’s] payment….” (Indiana Progressive Policy). Generally speaking you have to repay what you have received upon settlement of your injury case. When a medical payment is made on your behalf, a lien results which attaches to any settlement you make (called a “subrogation lien”).  According to Indiana law (Indian Code 34-51-2-19), if you have an attorney, your attorney is entitled to charge a fee to the insurance company for recovering the lien amount. In our office we charge a fee but do not keep that fee, we simply to reduce the amounts to be repaid. In essence that money goes to you, the client!

In addition, if you have an attorney he may find other ways to reduce what has to be repaid in subrogation. Under our “lien reduction statute” (Indiana Code 34-51-2-19) if you do not receive 100% of what you were entitled to receive in settlement of your case then the carriers who subrogate for medical expenses likewise have to reduce what they receive.  For example your case is valued at $100,000 but only $50,000 is paid to you (limits of the wrongdoer’s insurance policy). In such a case, your med pay carrier’s lien amount is reduced by 50% and your attorney can then reduce it further by his percentage fee (typically 1/3).

Call Us for a Free Consultation

At the law office of William “Bill” Hurst we will help you get the money you deserve from your accident. Don’t let insurers or medical providers talk you out of what you are entitled to! Contact or Call our office at 1(800)636-0808 for a free consultation or visit our website at www.https://billhurst.com/m. ¡Hablamos Español!spanish

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William W. Hurst

Bill Hurst has successfully represented hundreds of accident victims, and has limited his practice to personal injury cases for over thirty-five (35) years.


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