6.3 Part B Medical Payments

Part B - Medical Payments Coverage

Part B pays reasonable and necessary medical and funeral expenses incurred because of bodily injury caused by an auto accident. It is a no-fault, first-party coverage: it pays regardless of who caused the accident, so an at-fault insured still collects.

Expenses must be incurred within three years of the date of the accident. Med Pay is relatively inexpensive - roughly 5% of the auto premium - and its purpose is to provide quick payment for injuries before fault is sorted out, often functioning as a bridge ahead of any liability or health-insurance settlement. It is optional coverage in most states but mandatory in a handful.

Who Is an Insured Under Part B

There are two categories of covered person, and the asymmetry between them is heavily tested:

1. You or any family member while occupying any auto, or as a pedestrian struck by a motor vehicle designed for use on public roads.
2. Any other person while occupying your covered auto (passengers riding with permission).

Occupying is defined as in, upon, getting in, on, out, or off the vehicle - so a person entering or exiting is still an occupant. Note the asymmetry: you and family members are covered in any auto and even as pedestrians, while other passengers are covered only while inside your covered auto.

Limits

Part B limits are stated as a per-person amount (for example, $5,000 each person). The limit applies separately to each insured person injured in an accident - there is no per-accident aggregate cap. So if the limit is $5,000 each and four covered people are hurt, up to $20,000 is available across the four claimants.

Worked example: The limit is $10,000 per person. The driver incurs $8,000 in covered medical bills and a passenger incurs $14,000. Part B pays the driver $8,000 (in full) and the passenger $10,000 (capped at the per-person limit). The passenger's remaining $4,000 is not covered by Part B but may be recoverable under Part A from an at-fault party or under the passenger's own health or auto coverage.

Key Part B Exclusions

Part B contains numerous exclusions that mirror the Part A liability exclusions and push specialized exposures onto coverages designed for them:

• Injury while occupying a vehicle with fewer than four wheels (such as a motorcycle).
• Injury while the vehicle is used as a public or livery conveyance (ride-share for hire).
• Injury in the course of employment if workers compensation benefits are required or available.
• Injury sustained while using a vehicle without a reasonable belief of being entitled to do so.
• Injury arising from war, nuclear hazard, or racing activities on a track.

A frequently tested trap is the owned-but-not-insured exclusion: injury while occupying a vehicle, other than your covered auto, that is owned by you or a family member is excluded. You cannot use Med Pay on a second car you own but chose not to insure on this policy.

Med Pay vs. PIP and Other Coverage

In no-fault states, Personal Injury Protection (PIP) replaces or supplements Med Pay and adds wage-loss and essential-services benefits. Med Pay is purely medical and funeral expense. Part B typically coordinates with the insured's health insurance, and an other insurance clause generally makes it excess when the insured is injured in a non-owned vehicle.

A practical exam point: because Med Pay is no-fault and pays quickly, it often funds emergency treatment before a liability investigation concludes. The insurer that pays Med Pay may then pursue subrogation against an at-fault third party to recover what it paid, and the insured generally cannot collect twice for the same medical bill under both Part B and a Part A liability settlement.

Who Is Covered and How Med Pay Coordinates

Part B covers the named insured and family members while occupying any auto or as pedestrians struck by a motor vehicle, plus any other person while occupying your covered auto. It is no-fault within the policy — it pays the insured's own medical bills regardless of who caused the accident — and applies to expenses incurred within three years of the accident. Because it can overlap health insurance and Part C, the policy contains other-insurance language making PAP med pay excess or contributory depending on the circumstances.

Med Pay Exclusions

Part B does not pay for injury sustained while the vehicle is used as a public or livery conveyance, during business use of a non-owned vehicle, while occupying a vehicle with fewer than four wheels (motorcycles), to a person injured in a vehicle furnished for regular use that is not the covered auto, or for injury occurring during war or nuclear events. Knowing that med pay follows the person (family members in any car) while liability follows the car and permitted users is a recurring distinction.