6.3 Part B Medical Payments

Part B - Medical Payments Coverage

Part B pays reasonable and necessary medical and funeral expenses because of bodily injury caused by an auto accident and sustained by an insured. The defining feature - and the most-tested point - is that Part B pays regardless of fault. It is a no-fault first-party benefit that responds quickly without litigating who caused the accident.

What Part B covers

• Reasonable expenses for necessary medical, surgical, X-ray, dental, ambulance, hospital, professional nursing, and prosthetic services
• Funeral expenses
• Expenses incurred within 3 years of the date of the accident

The limit is shown per person (e.g., $1,000, $5,000, or $10,000 each person) and applies separately to each injured insured. Unlike Part A, there is no per-accident aggregate - each insured has the full per-person limit available.

Who is an insured under Part B

The Part B insured definition differs from Part A:

1. The named insured or a family member while occupying, or as a pedestrian struck by, a motor vehicle designed for use on public roads
2. Any other person while occupying your covered auto

Note the contrast: the named insured and family members are covered as pedestrians and while occupying any auto, but a non-family passenger is only covered while in your covered auto. "Occupying" means in, on, getting in, on, out of, or off the vehicle.

Worked coordination example

Med-pay frequently overlaps with health insurance and with Part A. Consider a $7,000 hospital bill for the named insured injured as a passenger in a friend's car, with a $5,000 Part B limit:

Part B pays the first $5,000 quickly without regard to fault. The remaining $2,000 may be sought from health insurance or pursued against the at-fault driver's Part A liability coverage. Med-pay does not require the insured to prove the other driver was negligent, which is why it settles faster than a liability claim.

Med-pay and subrogation

When Part B pays an insured who is later compensated by an at-fault third party, the insurer generally has a right of reimbursement or subrogation for amounts the insured recovers from the responsible party, preventing a double recovery for the same medical bills. The policy also requires the insured to submit to physical exams by the insurer's chosen physicians and to authorize release of medical reports and records.

Med-pay is excess over, and does not duplicate, any amount paid or payable under Part A or Part C of the same policy for the same expense - the insured cannot stack the same dollar of medical bill against two Parts. In no-fault (PIP) states, statutory personal injury protection may replace or sit alongside Part B; on the national exam, treat Part B as the standard fault-neutral medical benefit unless a question specifies a no-fault statute.

Key Part B exclusions

Part B does not pay for bodily injury:

• Sustained while occupying a vehicle with fewer than four wheels (e.g., a motorcycle)
• While the vehicle is used as a public or livery conveyance (taxi/for-hire)
• Sustained while occupying a vehicle the insured owns or has available for regular use that is not the covered auto
• Arising out of an auto-business operation or war
• Sustained while the vehicle is being used in the business of an insured, except a private passenger auto, pickup, van, or trailer
• Occurring during a racing or speed contest

A recurring trap: a person injured on a motorcycle has no Part B coverage because a motorcycle has fewer than four wheels.

Part B as No-Fault Within the Auto Policy

Medical Payments coverage is no-fault first-party coverage: it pays reasonable medical (and funeral) expenses for the insured and passengers regardless of who caused the accident, within a set time (often 3 years) of the accident.

Exam trap: Part B pays regardless of fault and is excess over other collectible sources in some structures, but it is not a substitute for liability - it pays the insured's own medical bills, while Part A pays others' injuries the insured caused. Watch answers that confuse the two.

Coordination and Stacking

When the same medical bill could be paid by Part B and by PIP, health insurance, or liability from an at-fault driver, anti-duplication and coordination rules prevent double recovery. Med-pay is popular because it pays quickly without proving fault and covers deductibles and copays other coverage leaves behind. It excludes injury sustained while the auto is used to carry persons for a fee or during business use of a non-owned vehicle, mirroring the liability exclusions.

Why Med-Pay Endures

Even where PIP or strong health coverage exists, insureds keep Part B because it fills coordination gaps: it pays deductibles and copays, covers passengers who may lack their own coverage, and pays family members injured as pedestrians struck by any auto. Limits are modest (commonly $1,000 to $10,000 per person), but the coverage is inexpensive and pays quickly without litigation, which is why exam scenarios often have Part B responding first for small injury bills while Part A handles the larger third-party liability.