6.3 Part B Medical Payments
Key Takeaways
- Part B pays reasonable medical and funeral expenses for covered injuries regardless of fault.
- Covered persons are the named insured and family members in any auto, plus any other person occupying your covered auto.
- Expenses must be incurred within a stated period (commonly three years) from the date of the accident.
- Pedestrian coverage applies when a covered person is struck by a motor vehicle or trailer.
- Part B coordinates with Part C and health insurance to prevent double recovery.
What Part B Covers
Part B - Medical Payments Coverage (often called Med Pay) pays reasonable expenses for necessary medical and funeral services because of bodily injury caused by an auto accident. The defining feature for the exam: Part B pays regardless of fault - it is a first-party, no-fault style coverage.
Because it ignores fault, Med Pay often pays quickly while a liability dispute is still pending against the other driver.
Covered Persons
Part B applies to two groups:
- You and any family member while occupying any auto, or when struck as a pedestrian by a motor vehicle designed for use on public roads (or a trailer of any type).
- Any other person while occupying your covered auto - for example, a friend riding as a passenger.
'Occupying' means in, upon, getting in, on, out, or off the vehicle. Trap: a family member injured as a pedestrian is covered, but a non-family passenger is covered only while occupying your covered auto, not someone else's car.
Limit and Time Window
The Part B limit is a per-person amount shown in the Declarations - common selections are $1,000, $5,000, or $10,000 per person. Each covered person has access to the full limit; it is not divided among occupants.
Covered expenses must be incurred within a defined period - commonly three years from the date of the accident. Costs first incurred after the window closes are not payable even if related to the original injury.
Worked example: Two passengers are injured in the insured's car under a $10,000 Med Pay limit. Each passenger may recover up to $10,000, so the coverage can pay up to $20,000 total for that accident.
Common Part B Exclusions
Med Pay tracks several Part A exclusions plus a few of its own:
- Injury while occupying a vehicle with fewer than four wheels (motorcycles).
- Injury while the covered auto is used as a public or livery conveyance (for-hire), excluding share-the-expense carpools.
- Injury during business use of a vehicle furnished for regular use other than the covered auto.
- Injury while using a vehicle without a reasonable belief of permission.
- Injury arising out of war, nuclear, or racing activities.
- Injury occurring while the auto is used as a residence or premises.
Coordination and No Double Recovery
Part B is designed to fill gaps and pay promptly, but the PAP prevents stacking the same dollars:
- The Other Insurance condition makes Part B excess over other applicable auto Med Pay when the injured person is in a non-owned auto.
- Amounts paid under Part B are generally not paid again under Part C (UM/UIM) or Part A for the same loss element.
- Med Pay may be coordinated with the injured person's health insurance, and the insurer may pursue subrogation where allowed.
This is why an exam answer that lets a claimant collect the same medical bill twice is usually wrong.
Why Med Pay Matters
Med Pay fills three practical gaps that exam questions probe:
- It pays the insured's own injuries, which Part A liability never does (Part A pays only other people).
- It pays immediately, without waiting to establish who was at fault, easing cash flow for medical bills.
- It supplements thin or high-deductible health plans and can cover funeral expenses, which most health insurance excludes.
Because it ignores fault, a producer can describe Med Pay as 'no-fault first-party' coverage - the insured collects even when the insured caused the crash.
Covered Expenses Defined
Part B pays reasonable and necessary expenses for services such as:
- Medical, surgical, X-ray, and dental services
- Ambulance, hospital, and professional nursing care
- Prosthetic devices
- Funeral services
The expense must be caused by an auto accident and incurred within the policy's time window. 'Reasonable' lets the insurer challenge inflated charges, and 'necessary' excludes elective or unrelated treatment. A bill for a pre-existing condition unrelated to the crash is not payable even if the timing overlaps.
Med Pay Versus Liability and PIP
Students confuse three injury coverages. Keep them straight:
| Coverage | Whose injuries | Fault required? |
|---|---|---|
| Part A Liability | Other people the insured injures | Insured must be at fault |
| Part B Medical Payments | Insured, family, occupants of covered auto | No fault required |
| Personal Injury Protection (PIP) | Insured and occupants, broader (lost wages, services) | No fault; mandatory in no-fault states |
PIP is a statutory cousin of Med Pay used in no-fault states; it is broader because it can pay lost wages and essential services, while standard Med Pay pays only medical and funeral costs. In no-fault states, PIP often replaces or supplements Part B.
Watch the wording on exams: a question that lists lost wages or loss of essential services as a benefit is describing PIP, not standard Med Pay. Med Pay is intentionally narrow - medical and funeral only - which is also why its limits are low ($1,000 to $10,000) compared with the larger PIP packages mandated in no-fault jurisdictions. Choosing Med Pay versus PIP on a test usually turns on that wage-benefit clue.
Under Part B Medical Payments, which injured person is NOT covered?