6.3 Part B Medical Payments
Key Takeaways
- Part B is no-fault, first-party Med Pay for reasonable medical/funeral expenses incurred within 3 years of the accident.
- Limits are per person; the named insured and family members are covered broadly (any auto, even as pedestrians), while other passengers are covered only in your covered auto.
- Non-duplication language prevents collecting the same expense under Part B, Part C, and liability simultaneously.
- The owned-but-not-insured exclusion bars Part B when an insured is injured in an owned vehicle that is not a covered auto.
Part B: Medical Payments Coverage
Part B pays reasonable and necessary medical and funeral expenses caused by an auto accident and incurred within 3 years of the accident date. It is no-fault, first-party coverage: it pays for covered persons' injuries regardless of who caused the accident. Limits are stated per person (commonly $1,000 to $10,000) and apply separately to each covered person injured in an accident.
Who Is a Covered Person Under Part B
Part B covers two categories of person:
- You or any family member while occupying any auto, or as a pedestrian struck by a motor vehicle (or trailer) designed for use on public roads.
- Any other person while occupying your covered auto (passengers).
Note the asymmetry: the named insured and family members are covered very broadly — in any auto and even as pedestrians — while other passengers are covered only when they are inside your covered auto. "Occupying" includes getting in, getting out, on, or off the vehicle.
How Part B Relates to Part A and Part C
- Part B pays without regard to fault, so it responds quickly for the insured's own and passengers' immediate medical bills.
- It does not subrogate against the insured's own first-party recovery the way liability does, but the policy contains anti-stacking and non-duplication language so the same expense is not paid twice across Part B, Part C, and any liability recovery.
- Worked example: A passenger in your covered auto incurs $7,500 in ER bills after an at-fault accident by another driver. Your Part B (limit $5,000) pays $5,000; the remaining $2,500 is pursued against the at-fault driver's liability coverage. The passenger cannot collect the same $5,000 twice.
Part B Exclusions (Heavily Tested)
| Exclusion | Why |
|---|---|
| Occupying a vehicle with fewer than four wheels | Motorcycles need their own coverage |
| Vehicle used as a public or livery conveyance | Taxi/ride-hail passenger-carrying excluded (car pools OK) |
| Vehicle used in the auto business | Garage/dealer exposures excluded |
| Injuries during business use of a pickup/van not shown on the Declarations | Limits commercial exposure |
| War, nuclear, racing | Standard catastrophic exclusions |
| Occupying a vehicle (other than your covered auto) owned by you or a family member but not insured for Part B | Closes a coverage-gap trap |
The Owned-But-Not-Insured Trap
The most missed Part B point: if the named insured or a family member is injured while occupying an owned vehicle that is not a covered auto under the policy (for example, a second car insured elsewhere or not at all), Part B does not respond. This prevents an insured from buying Med Pay on one car and claiming it for injuries sustained in an uninsured owned vehicle. Always check whether the vehicle the insured was in is a covered auto.
A neighbor riding as a passenger in the named insured's covered auto is injured in an accident. Under PAP Part B, is the neighbor covered, and does fault matter?
Within how many years of the accident must medical expenses be incurred to be payable under PAP Part B?
What Part B Medical Payments Covers
Part B pays reasonable and necessary medical and funeral expenses, caused by an auto accident, for bodily injury to a covered person, regardless of fault, if expenses are incurred within a stated period (commonly three years) of the accident. It is first-party, no-fault-style coverage that pays quickly for the insured's own injuries and those of passengers, complementing the liability of Part A, which pays others harmed by the insured. The limit is a modest per-person amount, such as 5,000 or 10,000 dollars, applied to each injured covered person.
Who Is a Covered Person Under Part B
A covered person for Part B is the named insured and family members while occupying any auto or when struck as pedestrians by a motor vehicle, and any other person while occupying the covered auto. Note the broad pedestrian protection for the named insured and family: they are covered if hit by a car even when not in any vehicle. This pedestrian reach is a frequently tested feature, because candidates assume medical payments require occupancy of an auto.
How Part B Relates to Parts A and C
Part B and Part A can both respond to one accident but to different people: Part B pays the insured's own medical bills no matter who was at fault, while Part A pays the medical and other damages of third parties the insured injured. Part C (uninsured motorists) pays the insured's injuries when a negligent at-fault driver has no insurance. In states with no-fault PIP, statutory PIP may replace or supplement Part B. The exam tests which part responds by asking whose injuries are at issue and whether fault and the other driver's coverage matter.
Part B Exclusions and the Owned-But-Not-Insured Trap
Part B excludes injuries sustained while occupying a vehicle with fewer than four wheels (most motorcycles), while using a vehicle as a residence or premises, during business use of a vehicle other than a private passenger auto, while using the auto in the auto business, and from war, nuclear, and racing exposures. The owned-but-not-insured trap appears here too: it excludes injury while occupying a vehicle owned by the named insured or a family member that is not insured for this coverage under the policy. A family member injured in a second household car that was never added to the policy is therefore excluded, a classic exam denial.