What Is MedPay Coverage?
Medical Payments coverage (MedPay) is an optional auto insurance coverage that pays medical expenses for you and your passengers after an accident, regardless of who was at fault. It's designed to provide quick payment for medical bills without waiting for fault determination or other insurance claims to resolve.
What MedPay Covers
- Hospital and emergency room visits
- Doctor appointments and specialist visits
- X-rays, MRIs, and diagnostic tests
- Surgery and medical procedures
- Ambulance and medical transportation
- Dental work for injuries from the accident
- Some policies cover funeral expenses
What MedPay Does NOT Cover
- Lost wages or income
- Pain and suffering
- Property damage
- Long-term care or rehabilitation (in most policies)
- Injuries not related to the covered accident
MedPay pays regardless of fault. Even if you caused the accident, MedPay covers your injuries. This makes it the fastest source of payment for accident-related medical expenses.
MedPay vs. PIP vs. Health Insurance
Understanding how MedPay differs from other coverage helps you use it strategically:
| Feature | MedPay | PIP | Health Insurance |
|---|---|---|---|
| Medical expenses | Yes | Yes | Yes |
| Lost wages | No | Yes | No |
| Deductible | Usually none | Often yes | Usually yes |
| Affects health premiums | No | No | May |
| Subrogation rights | Varies | Limited | Usually yes |
| Typical limits | $1,000-$25,000 | $10,000-$250,000 | Policy max |
California is a "fault" state, not a "no-fault" state, so Personal Injury Protection (PIP) is not required or commonly offered. Instead, MedPay is the primary no-fault medical coverage available on California auto policies.
California insurers must offer MedPay coverage, though you can decline it. Common MedPay limits in California range from $1,000 to $100,000, with $5,000 being a typical selection.
Who Is Covered by MedPay?
MedPay coverage typically extends beyond just you:
Generally Covered
- You (the named insured) - in your own car, someone else's car, or as a pedestrian hit by a car
- Family members in your household - in the covered car, another car, or as pedestrians
- Passengers in your covered vehicle - regardless of their relationship to you
Coverage Scenarios
- Driving your own car: Full MedPay applies
- Passenger in someone else's car: Their MedPay may apply first, then yours as excess
- Pedestrian hit by a car: Your MedPay usually covers you
- Riding a bicycle hit by a car: Often covered under your auto MedPay
Coverage for motorcycles, ATVs, and commercial vehicles varies by policy. Some MedPay policies exclude these vehicles or have separate coverage requirements.
How to File a MedPay Claim
MedPay claims are generally straightforward, but following the right process ensures smooth payment:
- Report the accident to your insurer. Contact your auto insurance company promptly after the accident. Let them know you intend to use your MedPay coverage.
- Seek medical treatment. Get necessary medical care. MedPay typically has a time limit (often 1-3 years from the accident) during which treatment must occur.
- Gather documentation. Collect medical bills, records, and the police report showing the accident.
- Submit bills to your insurer. Send itemized medical bills to your MedPay claims adjuster. Many insurers have online portals for submission.
- Coordinate with health insurance if needed. If your MedPay limit is exhausted, your health insurance typically covers remaining expenses.
If you have both MedPay and health insurance, using MedPay first is often advantageous. MedPay typically has no deductible and doesn't affect your health insurance rates. It also may not have subrogation rights, meaning you might not have to repay it from a later settlement.
California Insurance Code Section 11580.2 and the Fair Claims Settlement Practices Regulations require insurers to process MedPay claims promptly. If your insurer unreasonably delays or denies payment, this could constitute bad faith.
MedPay, Subrogation, and Your Injury Settlement
One important consideration with MedPay is subrogation - your insurer's right to be repaid from any settlement you receive from the at-fault driver.
What Is Subrogation?
When your MedPay insurer pays your medical bills, they may have the right to be reimbursed from any liability settlement or judgment you later receive from the at-fault driver.
How Subrogation Varies
- Full subrogation: Insurer can recover all MedPay it paid from your settlement
- Limited subrogation: Insurer can only recover from the portion of settlement designated for medical expenses
- No subrogation: Some policies or states prohibit MedPay subrogation entirely
California allows MedPay subrogation, but under Insurance Code Section 11580.2(f), the insurer's subrogation rights are limited. The insurer can only pursue subrogation against the at-fault party's insurance, not against your settlement directly in most circumstances.
This means if you're the injured party and receive a settlement, your MedPay insurer generally cannot take a portion of that settlement for reimbursement. This is a significant advantage for California policyholders.
Understanding your MedPay policy's subrogation terms is crucial before settling an injury claim. If your insurer has full subrogation rights, the MedPay amount may effectively come out of your settlement. If there's no subrogation, you keep your full settlement plus you had the benefit of early medical bill payment.
Common MedPay Disputes
Treatment Relatedness
The most common dispute is whether treatment is related to the accident. Insurers may deny payment for:
- Treatment they claim is for pre-existing conditions
- Ongoing treatment they consider excessive
- Alternative treatments like chiropractic or acupuncture (though many policies cover these)
Timing Issues
- Delay in seeking treatment: If you wait weeks before seeing a doctor, insurers may question whether injuries are accident-related
- Policy time limits: Most MedPay has a window (often 1-3 years) during which treatment must be rendered
Resolving Disputes
- Request a written explanation for any denial
- Provide additional documentation from your doctor explaining medical necessity
- Get a letter from your doctor linking treatment to the accident
- File a complaint with your state insurance department if the denial seems unreasonable
Maximizing Your MedPay Coverage
Purchasing Adequate Coverage
MedPay is relatively inexpensive - often just $20-50 per year for $5,000-10,000 in coverage. Consider:
- Higher limits are worthwhile given the low cost
- Emergency room visits alone can exceed $5,000
- MedPay stacks with other coverages, so having it doesn't hurt
Using MedPay Strategically
- Use it early: MedPay gets your bills paid while fault is still being determined
- Avoid gaps in treatment: Consistent treatment supports relatedness
- Document everything: Keep copies of all bills, records, and correspondence
- Understand coordination: Know how MedPay coordinates with your health insurance
If you're a passenger injured in an accident, multiple MedPay policies may apply: the driver's MedPay, and your own MedPay (if you have auto insurance). You may be able to collect from both up to their respective limits.
When to Seek Legal Help
Most MedPay claims are straightforward, but consider consulting an attorney if:
- Your MedPay claim is denied and you believe the treatment was accident-related
- You have a larger injury claim and need help coordinating MedPay with your settlement
- Your insurer is demanding subrogation from your settlement in a state where that's not allowed
- Your medical bills significantly exceed your MedPay limits and you're pursuing other parties
- You're dealing with complex coverage issues involving multiple vehicles or policies
Related Guides
Need Help With Your MedPay Claim?
If your MedPay claim has been denied or you need help coordinating coverage after an accident, I can help you understand your options and fight for proper payment.