Medical Payments Coverage (Cont.)
If you have your own personal auto policy, your medpay coverage will always provide benefits unless you are driving a vehicle that you own or that is furnished for your regular use and that is not insured on the same policy that provides medpay coverage. Other than your own policy, you may also look to the following sources of medpay and collect from multiple policies to increase benefits available to pay accident-related medical costs:
- The auto policy for any non-owned vehicle that you occupy at the time of collision—if you are riding with a friend in his or her vehicle, you can collect from your friend’s policy and your own policy.
- A family member’s policy will provide coverage under that family member’s separate policy if the vehicle you occupy at the time of the accident is not owned by any family member or furnished for any family member’s use. “Family member” is defined as any person who lives with you at the time of the accident and is related to you by blood, marriage, or adoption, and this includes a ward or foster child.
If you incur medical expenses following an accident, always look to all available sources for medpay even if the accident is your fault.
Medical Payments Coverage Exclusions
Under the standard auto policy in North Carolina, an insurance carrier that provides medpay can limit the coverage by looking to the exclusions under the medpay policy. The following common exclusions limit medpay benefits. The insurer is not required to pay medpay for any injury:
- sustained while occupying the covered auto while it is being used as a delivery vehicle or taxi (this exclusion does not apply to carpools)
- sustained while occupying any vehicle that is being used as a residence
- occurring while the injury victim was engaged in the business of selling, repairing, servicing, storing, or parking vehicles (this exclusion applies only if workers’ compensation is available to fund medical expenses for the crash victims)
- for injuries to victims other than the named insured and family members when riding in a taxi or other nonowned auto used to carry persons or property for a fee
- sustained while occupying any motorized vehicle having fewer than four wheels—While we have seen medpay on motorcycle policies in very rare instances, the sole source of medpay for a motorcycle rider would be the single policy covering that motorcycle only if the insurance carrier collected a premium and provided medpay for that specific two or three-wheeled motorcycle.
Example: Triple Payment of Medical Bills
Andy is riding with his friend John when Alice runs a red light and collides with their vehicle. Andy incurs $30,000.00 in medical expenses due to the accident. Andy has a private health insurance policy that he pays for himself that pays his medical expenses directly. This type of health insurance has no right of reimbursement in North Carolina. Other than small copays, Andy’s $30,000.00 in medical bills are paid entirely by health insurance. John’s car insurance provides $5,000.00 in medpay coverage. Andy has his own policy with $25,000.00 in medpay coverage. Even though medical bills were already paid by health insurance, Andy can collect $5,000.00 from John’s medpay policy and $25,000.00 from his own policy. These funds are his to keep. Andy can then present his claims against Alice (and her liability insurers) for personal injury and collect medical expenses, lost wages, and pain and suffering. Here, Andy collects another $30,000.00 for his medical expenses plus Alice’s insurer must also pay for Andy’s lost wages and pain and suffering.
Notice that Andy collects three times for his medical bills! He received $30,000.00 from medpay and $30,000.00 from Alice after his medical expenses were paid in full by his health insurance carrier. While statutory changes have limited the triple recoveries, there are still cases where triple recovery can occur and double recovery of medical expenses remains quite common.