Part B Medical Payments

What Part B covers

Part B - Medical Payments pays reasonable expenses for necessary medical and funeral services caused by an auto accident and incurred within three years from the date of the accident. The defining feature is that it pays regardless of fault - it is a first-party, no-fault coverage. An insured does not have to prove anyone was negligent; the coverage responds because a covered person was injured.

Because it pays fast and without a liability fight, Part B is often the first money to reach an injured insured, supplementing or coordinating with the insured's health plan.

Limit structure

Medical Payments is written as a per-person limit - for example $5,000 each person. This is the maximum the insurer pays for each injured covered person from any one accident; it is not a per-accident pool divided among occupants.

If a car carrying four covered persons with a $5,000 Med Pay limit is in an accident and all four are injured, the insurer can pay up to $5,000 to each of the four, for as much as $20,000 total - one limit per person. Confusing Med Pay's per-person structure with a per-accident aggregate is a classic miss.

Worked example

An insured carries $10,000 Part B Medical Payments. Three covered occupants are hurt with bills of $12,000, $4,000, and $8,000.

Person 1's $2,000 excess is not covered by Part B; it may shift to health insurance, liability (if another party was at fault), or UM/UIM. There is no per-accident cap that reduces Persons 2 and 3 - each gets a full per-person limit.

Who is covered

Part B splits covered persons into two groups:

1. You and any family member while:
   • occupying (in, on, getting in, out of) any auto, or
   • struck as a pedestrian by a motor vehicle. Note this follows the named insured and resident relatives into any auto and even on foot.
2. Any other person while occupying your covered auto - a guest passenger in your insured car is covered, but only while in your covered auto, not while that guest is elsewhere.

The asymmetry is tested: a family member is covered in any car or as a pedestrian; a guest is covered only inside your covered auto.

Part B exclusions

Medical Payments does not apply when the injured person is:

• Occupying a vehicle used as a public or livery conveyance (share-the-expense car pools excepted).
• Occupying a vehicle with fewer than four wheels (motorcycles, mopeds).
• Injured during the course of employment if workers compensation is required and available.
• Occupying a vehicle (other than your covered auto) that is owned by or furnished for the regular use of the named insured or a family member but not insured under the policy (mirrors the owned-but-not-insured concept).
• Using the vehicle without a reasonable belief of being entitled to do so.

The motorcycle exclusion and the workers-comp overlap are the two exclusions most often tested on Part B.

Part B vs. Liability vs. PIP

Part B is no-fault, first-party coverage: it pays reasonable medical (and funeral) expenses for covered persons regardless of who caused the crash, usually within three years of the accident. It is excess over health insurance in practice and coordinates with PIP where a state mandates it.

Why MedPay Matters in Tort States

In an at-fault (tort) state like Colorado, there is no mandatory PIP, so MedPay fills the immediate-medical gap while fault and the liability claim are sorted out. It also covers the insured when struck as a pedestrian — a fact pattern the exam uses to separate MedPay (covered) from collision (not, since no owned auto is involved).

Worked Coordination Example

A passenger in the insured's car is hurt; medical bills total $9,000. The PAP Part B limit is $5,000 per person. Part B pays $5,000 regardless of fault; the remaining $4,000 must come from the passenger's own health coverage or, if the insured was at fault, from Part A liability (a third-party claim). Part B is a small, no-fault first-party cushion — it does not expand to cover the full bill.

The Family-Member vs. Guest Asymmetry

A family member hurt in a friend's car, or struck while walking, is covered by Part B; a guest is covered only inside the insured's own auto. This asymmetry is the most-tested Part B point.