6.3 Part B Medical Payments

Part B: Medical Payments Coverage

Part B - Medical Payments is a first-party, no-fault coverage built into the Personal Auto Policy. It pays reasonable and necessary medical and funeral expenses incurred because of bodily injury caused by an auto accident, regardless of who was at fault. Because Mississippi is a traditional tort (at-fault) state with no compulsory PIP, Part B Medical Payments is the principal first-party medical coverage Mississippi drivers buy, and the exam tests its scope closely.

What Part B Covers

Part B pays expenses for:

• Medical, surgical, X-ray, dental, ambulance, hospital, professional nursing, and prosthetic services.
• Funeral expenses, if the bodily injury results in death.

Expenses must be incurred within three years of the accident to be payable. Coverage is written as a per-person limit (commonly $1,000 to $10,000) that applies separately to each injured insured - there is no per-accident cap.

Who Is Covered Under Part B

Part B defines an insured more broadly than property coverage but in two situations:

1. You and family members while occupying any auto or as pedestrians struck by a motor vehicle (or trailer of any type).
2. Any other person while occupying your covered auto.

Exam trap: The named insured and resident family members are covered as pedestrians and in any auto. A non-family passenger is covered only while occupying your covered auto, not someone else's car.

Occupying Defined

The PAP defines occupying as in, upon, getting in, on, out, or off a vehicle. This broad definition means a person injured while loading groceries into the trunk, sitting on the hood, or stepping out of the car is "occupying" and therefore covered under Part B. Exam questions often describe someone partly out of the vehicle to test this definition.

Part B Exclusions

Medical Payments does not apply to bodily injury sustained:

• While occupying a vehicle with fewer than four wheels (motorcycles, mopeds).
• While occupying your covered auto when it is used as a public or livery conveyance (excluding share-the-expense car pools).
• While occupying a vehicle (other than your covered auto) furnished or available for the regular use of an insured.
• While using a vehicle without a reasonable belief of being entitled to do so.
• During the course of employment if workers' compensation benefits are available (avoids overlap with WC).
• From war, nuclear, or racing activity.

Coordination With Other Coverage

Part B is excess over other applicable coverage in some situations and may overlap with health insurance. After paying a Med Pay claim, the insurer holds subrogation rights against an at-fault third party only to the extent allowed; many states, however, restrict Med Pay subrogation. Med Pay is stackable across multiple vehicles on the same policy in many jurisdictions, increasing available first-party medical dollars.

Worked Example: Med Pay vs. Liability

A Mississippi insured carrying $5,000 Part B Med Pay and 25/50/25 Part A is at fault in a crash. The insured's own passenger (a non-family friend) incurs $8,000 in medical bills.

The same passenger's bills can draw on both Part B (first-party, no-fault) and Part A (because the insured was legally liable). Med Pay pays quickly without proving fault, then liability covers the balance. This dual-recovery scenario - first-party Med Pay layered beneath fault-based liability - is exactly the kind of distinction the Mississippi exam likes to probe.

Exam tip: Med Pay pays regardless of fault and applies to the insured's own occupants and the insured/family as pedestrians. Liability pays only when an insured is legally responsible to a third party.

Med Pay Compared to PIP and Health Insurance

Candidates frequently confuse Part B Medical Payments with Personal Injury Protection (PIP). PIP, found in no-fault states, is broader: it can pay medical bills plus lost wages, essential-services, and survivor benefits, and it bars certain lawsuits. Mississippi is a tort state with no mandatory PIP, so the PAP's narrower Med Pay - medical and funeral expenses only, no wage replacement - is the relevant first-party medical coverage here. Knowing that Med Pay excludes lost wages while PIP includes them is a classic exam discriminator.

Med Pay also differs from health insurance: it has no network restrictions, applies per accident up to a modest per-person limit, and pays quickly without subrogation delays in many states. Because it duplicates some health-plan coverage, an insured with strong health insurance may select a low Med Pay limit, while one with no health coverage benefits from higher Med Pay.

Exam tip: Med Pay applies to the named insured and resident family members in any auto and as pedestrians, but to all other occupants only in your covered auto. Match the injured person's status to the correct trigger before deciding whether Part B responds, and remember the three-year expense window and per-person (not per-accident) limit structure.