6.3 Part B Medical Payments
Key Takeaways
- Part B Medical Payments pays reasonable/necessary medical and funeral expenses regardless of fault.
- You and family members are covered while occupying any auto or as pedestrians struck by a motor vehicle; others are covered only in your covered auto.
- Limits are per person with no per-accident aggregate, so each injured insured has the full limit (e.g., $5,000).
- Expenses generally must be incurred within about 3 years of the accident.
- Exclusions mirror Part A (livery use, vehicles under four wheels, no reasonable belief of entitlement).
Part B: Medical Payments Coverage
Part B (Medical Payments) pays reasonable and necessary medical and funeral expenses incurred because of bodily injury sustained by an insured in a motor-vehicle accident. The defining feature — and the most-tested point — is that Part B pays regardless of fault. It is a "no-fault-style" first-party coverage within the PAP, separate from any state no-fault/PIP statute.
Expenses must be incurred within a stated period after the accident, typically 3 years from the date of the accident.
Who Is an Insured Under Part B
Part B uses a narrower, two-pronged definition of insured:
- You or any family member — while occupying any auto, or as a pedestrian struck by a motor vehicle (this follows the person).
- Any other person — only while occupying your covered auto (this follows the vehicle).
"Occupying" means in, upon, getting in, on, out, or off the vehicle. So you and your family are covered in your car, a borrowed car, or even as pedestrians; a guest passenger is covered only while in your covered auto.
Limits and How Part B Pays
The Part B limit is stated as an amount per person, per accident — common limits are $1,000, $2,000, $5,000, or $10,000 per person. There is no per-accident aggregate; each injured insured has the full per-person limit available.
Worked example: A PAP carries a $5,000 Part B limit per person. The named insured and two passengers are injured with medical bills of $4,200, $6,500, and $3,000. Part B pays $4,200 (full), $5,000 (capped — the $1,500 excess is unpaid by Part B), and $3,000 (full) = $12,200 total, because the $5,000 limit applies to each person separately.
Part B Coverage Triggers, Exclusions, and Coordination
| Feature | Rule |
|---|---|
| Trigger | BI by accident, arising out of maintenance/use of a vehicle as an auto |
| Fault | Paid regardless of fault |
| Time limit | Expenses incurred within ~3 years of the accident |
| Pedestrian | Covered for you/family struck by a motor vehicle |
Key exclusions mirror Part A: injury while the vehicle is used as a public/livery conveyance, injury during business use of vehicles you do not own in some cases, injury to a person occupying a vehicle with fewer than four wheels, and injury sustained while using a vehicle without reasonable belief of entitlement. Part B is excess over workers' compensation and other applicable coverages in some states and coordinates with PIP where required.
Part B Exclusions in Detail
The medical-payments exclusions reward careful reading. Part B does not cover bodily injury sustained:
- While occupying a vehicle with fewer than four wheels (a motorcycle), unless an endorsement adds it.
- While the covered auto is used as a public or livery conveyance (ride-share for hire), though share-the-expense car pools remain covered.
- While occupying a vehicle used in the business of an insured, other than a private passenger auto, pickup, or van.
- During the course of employment if workers' compensation benefits are required or available.
- While occupying a vehicle furnished or available for the regular use of the insured that is not the covered auto - the same regular-use logic as Part A.
- While occupying or struck by a vehicle being used without a reasonable belief of entitlement.
Coordination With Part A, PIP, and Health Insurance
A recurring exam theme is how Part B coordinates with other coverages. Part B pays the insured's own medical bills regardless of fault, while Part A pays others' bills only when the insured is liable - so in an at-fault accident, the insured's passengers might collect under both the insured's Part B and, if injured by the insured's negligence, conceptually under liability, but the policy contains anti-stacking and excess provisions to prevent double recovery from the same insurer.
In no-fault states, statutory PIP generally takes priority and Part B may be reduced, eliminated, or made excess. Where the insured also has health insurance, Part B typically still pays but the insurer may seek to avoid paying the same bill twice.
Why Part B Is Valuable Despite Small Limits
Though limits are modest, Part B is the fastest coverage to respond because it ignores fault and follows both the person (you and family anywhere, even as pedestrians) and the vehicle (guests in your covered auto). It fills the gap before liability is determined, covers the insured even when no one else is at fault, and reaches situations - like a family member injured as a pedestrian - that liability coverage would never touch. That breadth, not its dollar size, is what the exam tests.
A common comparison question pits Part B against UM/UIM: Part B pays the insured's own medical bills regardless of who caused the crash, whereas UM/UIM (Part C) pays only when an uninsured or underinsured other driver is legally at fault. When a single-car accident injures the insured with no other vehicle involved, Part B responds but Part C does not - a distinction worth memorizing as a classic Part B versus Part C exam contrast.
The named insured is a pedestrian struck by a car while crossing the street. Her own PAP has $10,000 Part B Medical Payments. Does Part B respond?
A PAP has Part B limits of $5,000 per person. Three insureds incur medical bills of $3,000, $5,000, and $7,000. What is the total Part B payment?