6.3 Part B Medical Payments

What Part B Covers

Part B — Medical Payments Coverage is a first-party, no-fault coverage. The insurer pays reasonable expenses for necessary medical and funeral services incurred by an insured who suffers bodily injury caused by an auto accident, regardless of who was at fault. Because fault is irrelevant, Part B is the fastest-paying auto coverage — it responds even when the insured caused the accident.

Expenses must be incurred within three years of the date of the accident. The limit is a per-person amount, commonly $1,000 to $10,000, and it applies separately to each injured insured.

Who Is Insured Under Part B

There are two classes of insured.

So the named insured and resident family members are covered as occupants of any car and even as pedestrians. A passenger who is not a family member is covered only while inside your covered auto.

Trap: A neighbor riding in your covered auto is a Part B insured; that same neighbor walking down the street and struck by a car is not covered by your Part B — only you and your family members get pedestrian protection.

Per-Person Limit and a Worked Example

Because the limit is per person, multiple injured occupants each have access to the full limit.

Assume Part B limit = $5,000 per person and an accident injures the named insured and two passengers:

There is no per-accident aggregate that reduces these payments — each person draws from a separate $5,000 limit. The named insured's $2,200 excess and Passenger 2's $1,000 excess can be pursued under health insurance, Part C, or against the at-fault party.

Part B Medical Payments — Scope and Insureds

PAP Part B – Medical Payments pays reasonable and necessary medical and funeral expenses caused by an auto accident, regardless of fault, for injuries sustained within three years of the accident. "Insured" under Part B means you and family members while occupying a vehicle or as pedestrians struck by a motor vehicle, and any other person while occupying your covered auto. It is a small, fast, no-fault coverage (typical limit $1,000–$10,000 per person) that coordinates with health insurance and reduces friction after minor crashes.

Part B Exclusions and Coordination

Part B will not pay when the insured is injured: while occupying a vehicle used as a public livery/ride-share for a fee; during business use of a non-owned vehicle with limited exceptions; while occupying a vehicle with fewer than four wheels; while in a vehicle the insured owns but did not insure under the policy (the owned-but-not-insured trap); or for injuries covered by workers' compensation.

Because Part B is per person and excess over some other coverages in practice, an exam scenario asking "how much does Med Pay owe each injured passenger?" is solved by applying the per-person limit to each occupant, not a per-accident cap — there is no per-accident aggregate on Part B.

Major Part B Exclusions

Part B does not pay for bodily injury:

• Sustained while occupying a vehicle with fewer than four wheels (motorcycles are not covered by a PAP's Part B).
• While the vehicle is used as a public or livery conveyance (carrying persons/property for a fee).
• Occurring during the course of employment when workers compensation is available.
• While occupying a vehicle without a reasonable belief of being entitled to do so (a thief or unauthorized user gets nothing).
• During racing or a speed contest on a track.
• From war, nuclear, or radioactive causes.
• While occupying a vehicle (other than your covered auto) that is owned by or furnished for the regular use of you or a family member — the so-called "owned-but-not-insured" exclusion that stops an insured from using one auto's Medical Payments to cover injuries in a second household auto that was never put on the policy.

How Part B Coordinates With Other Coverages

Medical Payments is excess in many states over personal injury protection (PIP) or health insurance, and policies contain anti-stacking and other-insurance provisions to prevent an insured from collecting the same medical bill twice. When an at-fault third party ultimately pays, the insurer may seek subrogation or reimbursement for what Part B advanced, depending on state law.

In no-fault states, mandatory PIP often replaces or supplements Part B and may also pay lost wages and essential-services costs that pure Medical Payments does not. On the exam, remember the core distinction: Part B pays medical and funeral expenses only, regardless of fault; PIP is broader (medical, wage loss, services) and is state-mandated where it applies.