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As an attorney helping injured clients navigate the waters of post-accident treatment, I read a number of accident reports and insurance policy declarations pages. When I meet with an injured client, I listen to the story of how the wreck occurred and assess the accident report to determine which driver is at fault for the accident. I must discuss medical care with a client. Eventually, the conversation turns to money and insurance. Does the injured client have health insurance? Is the client on Medicare or Medicaid? How will the necessary medical care be funded?

Most clients do not know their level of automobile insurance coverage.

Call your insurance agent. Go to your file cabinet or your insurance company’s website. Find your Declarations Page. And follow along with John Doe’s insurance policy:

Coverages Limits and Deductibles Premium
A. Bodily Injury $50,000 each person/ $100,000 each accident $40
B. Property Damage $25,000 each accident $16
C. Medical Payments $5,000 each person $4
D. Accidental Death $10,000 each person $2
E. Uninsured Motorists $50,000 each person/ $100,000 each accident $9
F. Collision $500 deductible $42
G. Comprehensive
J. Reimbursement for Emerg. Rd Srvc
$250 deductible

$30 each disablement

$15

$1

Coverage C, Medical Payments
(sometimes lumped together with Death benefits)

This applies when you are injured (or worse) in an accident. It can only go towards medical care or funeral bills. You and your lawyer, if you have one, may use these dollars to pay for your medical care. Your lawyer is not / should not be taking a fee on these dollars. According to policy language I found pertaining to “MED PAY”:

“We will pay reasonable expenses incurred for necessary medical and funeral services because of bodily injury:
1. Caused by accident; and
2. Sustained by an insured.

We will pay only those expenses incurred for services rendered within three years from the date of the accident. However, if the bodily injury is diagnosedwithin one year of the date of the accident and reported to us within three years of the date of the accident, we will not limit the time period in which we will pay reasonable expenses incurred for necessary medical and funeral services
resulting from such bodily injury . . .”

The policy language defines who is covered:

Division 1 – the named insured and, while residents of the same household, his spouse and any relatives . . .; or

Division 2 – any other person who sustained bodily injury, caused by accident while in or upon, entering or alighting from the automobile while being used by or with the express or implied permission of the named insured or spouse”

“$5,000 each person” Medical Payments
Let’s assume John Doe is injured in a wreck that is caused by Adverse Driver. John Doe treats with a orthopedist and a physical therapist for 4 months before he is better. He racks up $10,000 in medical bills before his doctors make him great again. Doe’s bodily injury and loss of earnings claims may be worth over $20,000, but Adverse Driver’s policy only affords coverage up to 15,000.

John Doe can ask his auto insurer to pay $5k from his Med Pay towards his doctor bills. He can also pursue Adverse Driver’s insurance policy to help him with the remainder of the medical bills, his lost wages, and compensation for his harms and losses occasioned by the wreck.

The following posts will address Accidental Death benefits, Damage to Owned Automobiles (Comprehensive & Collision), and UM/UIM (Uninsured Motorist Coverage).