Medical Payments Coverage, known as Med Pay for short, is a type of optional car insurance in California that covers medical bills and funeral expenses for policyholders and their passengers, regardless of who is at fault for an accident.
Other advantages of Med Pay insurance include that the policyholder and his or her family members can also claim damages (up to policy limits) if they are:
- Hit by a vehicle while they are a pedestrian,
- Injured while a passenger in someone else’s car, or
- Injured while taking public transportation. 1
To help you better understand Med Pay insurance, our California personal injury lawyers discuss, below:
- 1. What is California Med Pay insurance?
- 2. What are the advantages to Med Pay insurance?
- 3. Do I need medical payments insurance in California?
- 4. Will making a claim cause my premiums to go up?
- 5. Should I use Med Pay if I have other insurance?
- 6. Do I have to pay my auto insurer back if I get money in a settlement?
- 7. What policy limits are available for medical payments coverage in California?
“Med Pay” is short for “medical payments coverage.” In California, it is optional first-party insurance that people can elect to add to their auto policy.
Med Pay covers reasonable and necessary bills when the policyholder or his or her family is injured in an accident involving a vehicle, regardless of who is at fault.
Examples of when Med Pay might apply include:
- You are injured in a truck accident while driving home from work;
- You suffer a spinal injury when you are injured in an accident while taking Uber;
- A passenger on your motorcycle suffers a head injury after a car accident;
- Your child suffers a wrongful death in a bicycle accident;
- Your spouse is injured in a “pedestrian knock down.”
Payments made under Med Pay are made directly to a doctor or hospital. There is no need to pay most expenses out of pocket and submit the bills for reimbursement or to wait while the insurer investigates the accident, even if you were at fault.
Other advantages to Med Pay include:
- No deductibles or co-pays;
- No restriction on the type of provider you can visit;
- Covers both you and your immediate family when:
- You are a passenger in someone else’s vehicle;
- You are a pedestrian hit by a vehicle, or
- You are injured while on public transportation.
Med Pay covers all reasonable and necessary medical bills and/or funeral expenses up to the policy limits. Such expenses can include (without limitation):
- Doctor’s bills;
- Hospital bills;
- Ambulance and EMT bills;
- Chiropractor or acupuncture bills;
- Physical or occupational therapy;
- X-rays and MRIs;
- Short- or long-term care (including home health care);
- Medical equipment (such as crutches);
- Prosthetics; and
- Dentist’s bills to fix broken teeth.
California medical payments insurance does not cover:
- Car repair bills;
- Costs of property damage to fences, gates, etc.;
- Coverage in excess of policy limits;
- Expenses not related to the accident; or
- Accidents not involving a vehicle (for example, horseback riding accidents).
Med Pay insurance is particularly good for people who have no health insurance or whose insurance has high deductibles or co-pays.
But even people with good health insurance may wish to purchase Med Pay. Med Pay also covers passengers in the policy holder’s vehicle, whether or not they have health insurance.
And unlike many health plans, it has no limit on the types of services or providers the injured person can use.
Finally, Med Pay coverage is “per incident,” not per year. So there are no yearly caps such as are found in many policies of health insurance.
In California, an insurer cannot raise rates when an auto policyholder makes a claim and was not at fault.2
If you were at fault, it is up to the insurer whether to raise your rates.
Generally, yes. Med Pay insurance is “per incident.” This means it won’t affect any yearly or lifetime cap on payments you might have under your health insurance policy.
Med Pay may also be preferable if you have not yet met the yearly deductible on your health insurance or when you have large co-pays.
If you were at fault for an accident and the other party was not injured (or injured only slightly), you may be tempted not to put a claim through your auto insurer.
But California law requires people to report an accident to the DMV if anyone was injured (no matter how minor).3 Most insurance policies also have a similar requirement.
You may wish to read our article, 15 Steps to Take After a Car Accident in California.
Some doctors and facilities may accept a medical lien in California following an accident. A lien is a legally binding contract that allows the provider to get paid from any judgment or settlement the insured gets from a third party.
Not all providers are willing to accept a medical lien instead of insurance or cash. And the person receiving the treatment is still responsible to pay the bills if the final disposition is not in his or her favor.
This makes using Med Pay preferable to a medical lien in most situations.
Most Med Pay policies give the insurer a right to reimbursement. This is to prevent you from recovering money for medical bills from a third party and pocketing it instead of reimbursing your auto insurer.
However, most California Medical Payments coverage is subject to California’s “Made Whole” rule.
Under this rule, the insured must be “made whole” for his or her damages from the accident before having to repay the auto insurer a dime.4
Example: Ben is injured in a pedestrian knock-down when a delivery van hits him as he is crossing the street in Beverly Hills. He has Med Pay coverage with a $5,000 limit, but his medical bills total $15,000.
Ben submits the bills to his Med Pay, which pays $5,000 to Ben’s doctor(s). Ben is personally liable for the remaining $10,000. If Ben later receives a settlement of $10,000 from the delivery company, he gets to keep it (be made whole).
But if the deliver company were to pay him $25,000, his auto insurer would be entitled to reimbursement of the $5,000 it paid. This is because the $20,000 left over would be more than enough to make Ben whole.
Some health insurance policies provide explicitly that the “made whole” rule does not apply. Such provisions are legal in California.5
For example, such a provision may state:
“Health Plan shall be entitled reimbursement regardless of whether the total amount of the recovery of the insured on account of an injury or illness is less than the actual loss suffered by the insured. The proceeds of any judgment or settlement obtained by Health Plan or the insured shall first be applied to satisfy Health Plan’s claims, liens, and other rights.”6
An experienced California injury lawyer can read through your insurance policy and help you negotiate a settlement that will leave you something left over for your out-of-pocket expenses and pain and suffering.
By law, all companies selling motor vehicle insurance in California must offer optional Med Pay coverage with policy limits of at least $1,000.
But most insurers offer higher limits as well — typically $2,000, $5,000, $10,000 and $25,000.7
Some large insurers such as State Farm offer Med Pay coverage of up to $100,000. How much you should purchase depends on your budget and what other types of insurance you have.
Keep in mind that medical bills from an accident can easily run in the tens or even hundreds of thousands of dollars.
It makes sense, therefore, to take into account available Med Pay policy limits and costs when shopping for car insurance in California.
For additional help…
If you or a family member was injured in an accident involving a car, truck, motorcycle or another vehicle, we invite you to contact our California car accident lawyers for a free consultation.
Our experienced California injury attorneys may be able to help you recover compensatory damages for medical bills and pain and suffering – often without filing a lawsuit.
Call us 24/7 to discuss your case with a lawyer.
We may also be able to help you if you were injured in a car accident in Las Vegas, Nevada.
- Nager v. Allstate Ins. Co. (2000) 83 Cal.App.4th 284, 290.
- California Insurance Code 491.
- California Vehicle Code 16000 VC.
- 21st Century Insurance Company v. Superior Court (Quintana) (2009) 47 Cal. 4th 511.
- Samura v. Kaiser Foundation Health Plan, Inc. (1993) 17 Cal.App.4th 1284.
- This clause is an edited version of the one upheld in Samura v. Kaiser, note 5.
- See, e.g., Value Penguin, Medical Payments Coverage.