Medical Payments Insurance Coverage

          Do you know enough about Medical Payments (often referred to as ‘med pay’) insurance coverage to be able to answer the above questions? Allow me to share the experiences of two different clients that our firm represented which illustrates the benefits and/or consequences of having, and not having, ‘med pay’ coverage and which may provide guidance to you when deciding whether to purchase that coverage. 

Car Insurance Policy          It was a day like most spring mornings. Jane just dropped her kids off at school and was traveling through an intersection when another driver who wasn’t paying attention traveled through a red light and collided with Jane’s car. She was injured as a result of the collision and taken to the local hospital for treatment.  After numerous x-rays and CT scans, she was released later that day and was prescribed a regimen of physical therapy for her neck and back.

            Bruce was the coach of a local Little League baseball team.  He had gotten up early on a Saturday morning and was traveling in his car to the local recreation complex to get the field ready for play. While stopped at an intersection, he was rear-ended by a neighborhood teenager who was using his cell phone to text his employer that he was running late for work.  As a result of the collision, Bruce was transported to the local hospital where he was diagnosed with having suffered two fractured vertebrae in his neck.  He was kept in the hospital overnight and had surgery the next morning. He was discharged home on the third day and was prescribed a series of follow-up appointments with the local neurosurgeon.

          If you are like Jane and Bruce above, your day also begins with a commute (work, church, social activities, etc.).  The last thing you expect during that commute is to be involved in an automobile accident until…..you are traveling down the road and another driver crashes into you.  Unfortunately, you are now the victim of a negligent driver.

          Like Jane and Bruce, you may suffer injuries and be transported by ambulance to the local hospital for treatment of your injuries.  Even if you only suffer from minor injuries, you will likely have several follow-up medical appointments to treat your injuries, for which payment will be expected.  Have you given any thought as to how those medical expenses are going to be paid, when, and by whom?

          Jane had planned for the prospect of being injured in a vehicle, while Bruce had not.  In fact, you may be asking yourself the same questions that Bruce found himself (as well as many of our other clients) asking us:

  • Shouldn’t the ‘at-fault’ driver (or their insurance company) be required to pay for my medical appointments/treatment?
  • What if you are refused treatment for your injuries unless payment can be assured?
  • Are you able to pay these expensive medical bills out of your pocket? Should you have to?
  • What if the other driver’s insurance company refuses to pay because it believes YOU caused the wreck?
  • How do you get treatment to help aid in your recovery if the other driver’s insurance company refuses to pay for your medical bills until the conclusion of your case (which is what is usually done)?  You know, it’s the chicken and the egg theory:

you are not ready to settle your case because you don’t know what your total medical expenses will be until after you have finished treating

vs.

settle your case now with the insurance company to get money to pay for the medical care you’ve already incurred (while being required to sign a waiver giving the insurance company and negligent driver immunity from having to pay your future medical expenses for the injuries you sustained).                                               

          These questions and concerns could all be eliminated if you, like Jane above, have ‘med pay’ coverage, WHICH NOT EVERYONE DOES! 

          When you purchase automobile insurance coverage, or any point thereafter, you can add ‘med pay’ coverage to your policy - for an additional premium. ‘Med pay’ coverage is an optional, but extremely valuable, resource that can be used to pay for medical expenses in the event you are injured as a result of the use of an automobile.  To be clear, your injuries arising from the use of an automobile do not have to be the fault of another driver. Even if you are at fault for an accident and caused your own injuries, your med pay insurance coverage (if you have it) will pay for your medical expenses up to the limit of coverage you purchased.

          If you decide to purchase ‘med pay’ coverage as part of your insurance policy, you will need to select the amount of coverage you want to protect yourself.  Insurance companies in West Virginia typically offer coverages in the amounts of $1000, $5000, $10,000, or $25,000, depending on the company.  Obviously, the more coverage (protection) you buy the higher your premium will be, however the cost for med pay insurance is nominal compared to the other portions of your automobile insurance premiums.

          Many individuals make the decision to buy ‘med pay’ coverage based upon whether they have access to health insurance that would otherwise pay for their medical expenses.  In other words, if you already have access to health insurance, you may decide that you do not need medical payments coverage since you (by and through your health insurance) will have the means to pay any medical expenses you incur, from any cause. 

          On the other hand, if you do not have access to health insurance coverage, ‘med pay’ coverage is an alternative form of protection for you and your family. Please note that med pay coverage only applies when the medical expenses are incurred as a result of the use of an automobile.  It is not available for you or your family for medical expenses that arise as a result of sickness or injuries that are not from the use of an automobile. 

          We strongly urge everybody to purchase med pay insurance coverage as part of their automobile insurance policy if they do not have health insurance available to pay for medical treatment.  The consequences of failing to do so can be extremely detrimental to you.

          As this article started, you were given the perspective of two different clients whose injury cases were handled by our law firm.  Long prior to her car accident, Jane had purchased insurance coverage on her vehicle from her local agent.  When selecting her insurance coverage, she chose to add medical payments insurance coverage in the amount of $25,000 in the event she incurred medical expenses as a result of an automobile accident. Jane was a single mother and did not have health insurance coverage through her employment, even though she made a good salary.  As a result of her prudent decision to purchase ‘med pay’ coverage, she had plenty of coverage to pay for the medical treatment she needed to recover from her injuries without having to wait until the conclusion of her case, or without feeling pressured to settle her case quickly before she had completed her medical treatment.

          Like Jane, Bruce also did not have health insurance available to pay for his medical expenses.  Unlike Jane, however, he failed to purchase the additional optional medical payments insurance coverage from his local agent.  Additionally, he did not have the financial means to pay for his medical treatment out of his pocket.  As a consequence, Bruce’s medical bills started arriving in his mailbox within a few weeks. Because he could not pay those bills, the hospital turned his account over to bill collectors and his credit rating was damaged.  Accordingly, he was left in a position of risking not getting the treatment he needed, not to mention the financial harm to his family.

          All of this can be a bit overwhelming, especially if you have never experienced this type of incident before. The attorneys and staff at The Miley Legal Group are highly skilled and experienced in setting up claims with the insurance companies and assisting victims of negligent drivers.