6.3 Part B Medical Payments

What Part B Pays

Part B - Medical Payments Coverage pays reasonable and necessary expenses for medical and funeral services because of bodily injury caused by an auto accident and sustained by an insured. Coverage is no-fault: it pays regardless of who caused the crash, which makes it fast first-aid money distinct from the fault-based Part A.

A key timing rule: expenses must be incurred within three years of the date of the accident to be payable. The amount paid is subject to the per-person limit shown on the Declarations (commonly $1,000 to $10,000).

Who Is an Insured for Med Pay

Two groups are covered:

1. You or any family member while occupying (in, on, getting in or out of) any auto - including someone else's car - or while struck as a pedestrian by a motor vehicle designed for road use.
2. Any other person while occupying your covered auto - i.e., your passengers.

Notice the broad reach for the named insured and family (covered as passengers in any car or as pedestrians), versus the narrow reach for guests (covered only in your covered auto).

Per-Person Application of the Limit

The Med Pay limit applies separately to each person injured. This is a common exam trap: it is a per-person limit, not a single per-accident cap.

Worked Example

A driver carries $5,000 Med Pay and is in a crash with three injured insureds:

Total Med Pay paid = $11,000, even though the per-person limit is only $5,000, because the limit resets for each insured. The front passenger's excess $2,500 may be recovered from the at-fault party or other coverage.

Coordination With Other Coverage

Med Pay is often excess over other applicable health coverage or, in some states, coordinated with Personal Injury Protection (PIP) in no-fault jurisdictions. It does not require fault and pays quickly, so it commonly funds initial treatment while liability is sorted out.

Unlike Part A, there is no duty to defend under Part B - it is purely a benefit payment, not a liability indemnity, so no supplementary payments attach.

Exclusions

Med Pay does not cover bodily injury sustained:

• While occupying a vehicle with fewer than four wheels (motorcycles, mopeds).
• While the vehicle is used to carry persons or property for a fee (livery), except share-the-expense car pools.
• During racing or speed contests.
• While occupying a vehicle used as a residence or premises.
• While using a vehicle without a reasonable belief of permission.
• During the course of employment if workers' compensation benefits are required and available.

The four-wheel rule is heavily tested: a passenger hurt on the insured's motorcycle gets no Med Pay under the auto PAP.

Med Pay vs. Liability vs. PIP — The Distinction Examiners Love

Candidates lose points confusing the three injury coverages. Lock in these contrasts:

Med Pay is a quick, low-limit goodwill/first-aid benefit. It does not pay lost wages, rehabilitation, or pain and suffering — those distinguish it from PIP and from a liability recovery.

Subrogation and Coordination Nuances

Because Med Pay pays without regard to fault, the insurer often retains subrogation to recover its payment from the at-fault driver's liability insurer once fault is established, preventing double recovery. In coordinated-benefits states, Med Pay may sit excess of the injured person's health insurance.

Worked coordination example: an insured passenger incurs $8,000 in bills. Med Pay limit is $5,000; the at-fault driver's BI liability later pays the full $8,000. The insured cannot keep $13,000 — the Med Pay insurer subrogates to recover its $5,000 from the liability settlement, leaving the insured made whole at $8,000.

Exam traps to memorize: the three-year filing window for incurred expenses; the four-wheel rule (no Med Pay for motorcycle/moped occupants); guests are covered only in your covered auto, while you and family members are covered as occupants of any auto or as pedestrians; and the workers'-comp exclusion when an on-the-job injury is covered by comp.

Pedestrian and Multi-Car Drills

Med Pay's reach differs sharply between the named insured/family and mere guests. Practice these:

The pattern: you and family members are covered as occupants of any auto and as pedestrians, while guests are covered only in your covered auto.

Coordination Sequence and a Worked Subrogation

Because Med Pay pays without regard to fault, it functions as fast first-aid money and is frequently excess over the injured person's health insurance, or coordinated with PIP in no-fault states. After fault is established, the Med Pay insurer often subrogates against the at-fault liability carrier.

Worked example: the named insured incurs $6,500 in medical bills and carries $5,000 Med Pay. Med Pay pays $5,000 immediately. The other driver is later found 100% at fault and their BI liability pays the full $6,500. The insured cannot keep $11,500; the Med Pay insurer recovers its $5,000 from the liability settlement, leaving the insured made whole at $6,500.

Exam traps: the three-year window to incur expenses; no duty to defend under Part B (it is a pure benefit, so no supplementary payments attach); the four-wheel exclusion (no motorcycle/moped occupants); the livery-for-fee exclusion (car-pool cost-sharing still covered); and the workers'-comp exclusion when comp benefits are required and available. Med Pay does not pay lost wages, rehabilitation, or pain and suffering — those distinguish it from PIP and from a liability recovery.