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MedPay Coverage

In previous posts, we have discussed that the state of Florida is a no-fault state and requires that all insured drivers carry $10,000 of Personal Injury Protection (PIP) that covers 80% of any medical bills that are directly related to injuries sustained in an auto accident. What recourse to do you have for the remaining 20% co-pay?

One option is MedPay or Medical Payment Coverage. In Florida, this is an optional provision that may entitle you to full payment of your medical bills. MedPay is additional coverage that ensures that 100% of your medical bills are paid up to a certain coverage limit.

MedPay, like PIP, is considered a first-party claim. First-party claims are claims that you make against your own insurance company, rather than against another party’s insurance. When you make a claim against the negligent driver’s insurance carrier, it is called a third-party claim.

Like PIP, MedPay covers medical bills without regard to fault; however, it cannot be used for costs outside of medical coverage such as loss of income. The strongest upside to MedPay is that MedPay can cover deductibles, coinsurance, and copays of other types of insurance, including PIP coverage. Furthermore, MedPay will cover the insured (you), any of your passengers, and any pedestrians or bicyclist that you strike. It may also cover you when you’re injured as the passenger in someone else’s car.

Examples:

  1. You are in a car accident. Your hospital bill is $2000. PIP pays the hospital $1600, which is 80% of your hospital bill. If you purchased MedPay on your auto insurance, it will pay the hospital the remaining $400, which is the 20% co-payment not covered by PIP.
  2. You are in a car accident. Your PIP coverage has a deductible of $500. Your hospital bill is $2500. PIP pays the hospital 80% above your deductible, which is $1600 [($2500-$500)*.8)]. If you purchased MedPay on your auto insurance, it will pay the hospital $400, which is the 20% co-payment not covered by PIP. In some instances, your insurance will state that MedPay will cover the deductible. If this is the case, MedPay will also pay the $500 not paid by PIP. So, in total, if you have MedPay on your auto insurance policy, and it states that it pays the deductible, it would pay $900 to the hospital in this case.
  3. Suppose you run a stop sign and hit another car. Your hospital bill is $1000. PIP pays the hospital $800, which is 80% of your hospital bill. If you opted for MedPay, it will pay the hospital $200, which is the 20% co-pay not covered by PIP. MedPay will pay this amount even if you are at fault!
  4. You are riding a bicycle and are hit by a car. Your hospital bill is $1000. PIP pays the hospital $800, which is 80% of your hospital bill. If you opted for MedPay, it will pay the hospital $200, which is the 20% co-pay not covered by PIP. The same would be true if you were injured as a pedestrian. MedPay will pay this amount even if you are at fault.
  5. If you let someone borrow your vehicle, he/she may be covered under MedPay coverage even if he/she has their own PIP coverage. With your friend’s permission, you borrow his car and are in a car accident. Your hospital bill is $1000. You own a car so your own PIP pays the hospital $800, which is 80% of your hospital bill. If you opted for MedPay, it will pay the hospital $200, which is the 20% co-pay not covered by PIP. MedPay will pay because you are a permissive (were given permission) user of your friend’s car. If your PIP had a deductible, your friend’s MedPay may cover your deductible as shown in Example #2 above.

Kovar Law Group Can Help:

Kovar Law Group will gladly review your insurance policy and discuss with you your coverage and potential vulnerabilities. Furthermore, if you’ve been in a car accident, the best thing you can do is seek the help of an experienced attorney. At Kovar Law Group we are well-versed in dealing with these issues and are proficient in gathering the required evidence to secure the best possible outcome. Schedule a free consultation with Kovar Law Group today.

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