Medical payments coverage is optional coverage in an Florida car insurance policy. Medical payments coverage is also known as Med-Pay.
I’m going to give examples of how Medpay applies in a car accident case. We’ll also discuss whether you have to repay Medpay from a personal injury settlement.
Since I practice in Florida, the focus will be on Florida car accident cases. However, I’ll also explain how Medpay applies if people from other states are injured in a Florida car accident.
Most drivers in Florida do not carry Med-Pay. Most often, medical payments pays the 20% co-pay that is not paid by P.I.P.
Let’s look at some examples of how Medpay pays medical bills.
Example #1 – Medpay Pays 20% Co-Payment
You are in a car accident. Your hospital bill is $1,000. You give your auto insurance information to the hospital when you are admitted to the hospital. P.I.P. pays the hospital $800, which is 80% of your hospital bill. If you purchased Med-Pay on your auto insurance, it will pay the hospital $200, which is the 20% co-payment not covered by P.I.P.
Check if Medpay Policy Says it Pays the Deductible
Sometimes Med-Pay will pay the P.I.P deductible.
You are in a car accident. You have a P.I.P. deductible of $500. Your hospital bill is $1,000. P.I.P. pays the hospital 80% above your deductible, which is $400 [($1000-$500)*.8)]. If you purchased Med-Pay on your auto insurance, it will pay the hospital $100, which is the 20% co-payment not covered by P.I.P.
If your auto insurance policy states that Med-Pay will pay by the deductible, it will also pay the $500 not paid by P.I.P. in this particular case. So if you have Med-Pay on your auto insurance policy, and it states that it pays the deductible, it would pay $600 to the hospital in this case.
Med-Pay is not dependent on fault.
Medpay Pays Even if You’re At Fault (Example)
You run a red light and hit another car. Your hospital bill is $1,000. P.I.P. pays the hospital $800, which is 80% of your hospital bill. If you purchased Med-Pay on your auto insurance, it will pay the hospital $200, which is the 20% co-payment not covered by P.I.P. Med-Pay will pay this amount even if you are at fault.
Most of the auto policies that I have seen that have Med-Pay offer it in the amount of $5,000.
Example #4
You run a red light and hit another car. Your hospital bill is $15,000. P.I.P. pays the hospital $10,000, which is the limit of the basic P.I.P. If you purchased $5,000 of Med-Pay on your auto insurance, it will pay the hospital $5,000, which is the 20% co-payment ($2,000) not covered by P.I.P and 100% of the covered charges until med-pay is exhausted ($3,000).
Med-Pay will pay this amount even if you are at fault.
Who Does Medpay Cover?
Medpay normally pays for the medical bills of the insured, insured’s family and passengers, in the same situations where P.I.P. coverage would pay. Examples are if you are in another person vehicle, as a bicycle rider, as a pedestrian, and more.
Example 5
You are a passenger in a friend’s car. You are in a car accident. Your hospital bill is $1,000. P.I.P. pays the hospital $800, which is 80% of your hospital bill. If there is med-pay coverage on the car, it will pay the hospital $200, which is the 20% co-payment not covered by P.I.P.
The same would be true if you were injured as a pedestrian, or if you are injured while riding a bicycle. Med-Pay will pay this amount even if you are at fault.
I wrote some interesting articles about whether you have a case if you are injured as a pedestrian in Florida, and who pays your medical bills if you are hit while riding a bicycle.
If you let someone borrow you vehicle, he or she may be covered under med-pay coverage even if he or she has his or her own P.I.P. coverage.
Example #6
Your friend lets you borrow his car. You are in a car accident. Your hospital bill is $1,000.
You own a car so your own P.I.P. pays the hospital $800, which is 80% of your hospital bill. If there is med-pay coverage on your friend’s car, it may pay the hospital $200. In this example, the $200 is the 20% co-payment not covered by PIP.
Med-pay will pay because you are a permissive user of your friend’s car. In another words, you were given permission to use someone’s car.
If your P.I.P had a deductible, your friend’s med-pay may cover your deductible as shown in Example #2 above.
Unlike P.I.P., med-pay normally does not pay for lost wages or disability, household services or death benefits.
Medpay Doesn’t Pay for Lost Wages
Assume that you’re in a car accident. Your hospital bill is $1,000. P.I.P pays the hospital $800, which is 80% of your hospital bill. You are unable to work for 2 weeks.
You hire a maid and gardener to cut your grass because you are unable to perform these tasks because of your injury.
If you purchased Med-Pay coverage on your auto insurance, it will pay the hospital $200, which is the 20% co-payment not covered by PIP.
But Medpay generally will not pay for your lost wages from the 2 weeks of work that you missed, for your gardener or for your maid.
P.I.P. would pay for these.
Will Medpay Cover You if You’re Driving a Vehicle for Work?
I’ve seen car insurance policies that don’t give the injured person Medpay benefits if he or she is entitled to workers’ compensation.
For example, I represented a Georgia resident who in Florida on a work trip. While driving a rental car, another driver hit him. He broke his leg.
My client had a car insurance policy on his personal vehicles. Travelers Insurance Company insured those cars with Medpay and uninsured motorist insurance coverage.
However, since he received workers’ compensation benefits, Travelers denied coverage for Medpay.
That said, it wasn’t a big deal. We settled his personal injury claim for $300,000. Allstate (the at fault driver’s insurance company) paid $100,000 to settle.
Travelers, my client’s underinsured motorist insurer, paid $200,000. This is one of several of my injury settlements with Travelers.
Do Ubers or Lyft Have Medpay?
Uber’s and Lyft’s auto insurance policy doesn’t include Medpay in Florida.
However, they both have PIP coverage which pays up to $10,000 for each person for your injuries. They paid 80% of the medical bills up to $10,000.
Also, rental companies don’t typically have Medpay on their auto insurance policies. Therefore, don’t expect Dollar, Thrifty, Alamo, National, Enterprise or Sixth to have Medpay on their policies.
Do You Have to Pay Medpay Back if Settle a Personal Injury Case?
Maybe. It depends on whether Medpay is entitled to be paid back.
However, a Medpay insurer must reduce the pay back amount by pro-rata attorney’s fees, costs, and other factors. This applies for Medpay on Florida car insurance policies.
Throughout my blog, I don’t try to sell people on hiring me. I mainly focus on providing valuable content to help people level the playing field with insurance companies.
Yes, I think that anyone who is seriously injured should hire a personal injury lawyer. However, I don’t really try to make my blog a sales pitch.
That said, there are 13 reasons to hire a personal injury lawyer. One of those reasons is because a Medpay insurer must reduce it’s repayment claim by your attorney’s fees and costs.
Again, I’m talking about Florida car insurance policies. This can result in a big savings to the injured person.
(I talk about how Medpay works in out of state insurance policies in a moment.)
Can Medpay Lose Its Right to Get Repaid from a Personal Injury Settlement?
Yes. In Florida, Medpay can lose its recovery right if it doesn’t ask for it in writing. Let me explain.
The injured person should quickly send a letter (via certified mail) to the Medpay insurer asking if it is claiming reimbursement. (Personal injury lawyers, like myself, have these forms handy.)
If the Medpay insurer fails to timely respond, it loses its subrogation right.
There is another situation where the Medpay insurer won’t likely ask to get paid back. That is, when the person who caused the accident is the same person whose insurance policy provided the Medpay benefits.
For example, let’s say that John is a passenger in Mike’s car. GEICO insures Mike’s personal car with Medpay coverage.
Mike crashes into the car in front of him. Assume that Mike was 100% at fault.
As a result of the crash, John gets injured. He breaks his arm.
Assume GEICO pays for John’s hospital bill under the Medpay coverage. In this instance, Mike was at fault for the crash. Thus, GEICO won’t ask for John to pay it back for Medpay benefits that it paid.
Why not?
Because GEICO’s insured (Mike) was at fault for the accident. GEICO won’t make a subrogation claim against its own insured.
I’ve settled many personal injury claims for a broken arm.
How Does Medpay Apply if You’re from Another State and You Get Hurt in a Florida Car Accident?
So far, I’ve mainly talked about Medpay coverage in Florida car insurance policies. Now, I’ll explain how Medpay works if an out of state visitor is hurt in a Florida car accident.
Florida is a popular state for tourism. And I’ve been privileged to represent many out of state visitors who were hurt in car accidents in Florida.
Often times, out of state visitors are in Florida for vacation. Perhaps they were here on a trip to Disney World or Universal Studios.
Let’s assume that Medpay from an out of state car insurance policy pays some of the injured person’s medical bills. The out of state law will likely determine if the injured person must repay the Medpay insurer.
This means that you will be dealing with the laws of two different states. Just dealing with Florida law is confusing enough. I have over 700 articles on Florida law on my blog. And this blog just skims the surface.
When we start dealing with the laws of two states, things can get complicated real fast.
Some States Don’t Require You to Pay Back Medpay
Getting into a car accident isn’t fun. That said, there is some good news for people who are injured in Florida car accidents while visiting from certain states.
Some states don’t allow the Medpay insurer to claim a lien on the settlement. Virginia is one state that follows this rule. Code of Virginia § 38.2-2209
Let me give you an example.
Assume Mike lives in Virginia. While visiting Florida, he is injured in a car accident. He breaks his wrist, or suffers a herniated disc.
Assume Mike’s Virginia car insurance company pays some of his bills under its Medpay coverage. If this happens, Mike doesn’t have to pay his car insurance company back if he settles his personal injury case with the responsible party.
However, an injured person doesn’t have to repay Medpay benefits an uninsured motorist insurance settlement.
North Carolina doesn’t allow a car insurance company to require its insured to pay it back for Medical Payments coverage if he or she settles an injury case. 11 N.C.A.C. § 12.0319. Thus, a North Carolina resident who is injured in Florida doesn’t have to pay back his or her auto insurer if he reaches a settlement with a driver.
Does California Medpay Require Repayment for a Florida Car Accident?
California car insurance companies must reduce their Medpay lien by the injured person’s attorney’s fees and costs). Lee v. State Farm Mut. Auto. Ins. Co. (1976) 57 Cal.App.3d 458, 465-466, 129 Cal.Rptr. 271.
I know this because I represented a California resident who was hurt in a Florida car accident. Doug was a pedestrian who was crossing the street in Miami Beach, Florida.
A driver hit him. As a result of the accident, he broke his leg (tibia). Fortunately, he didn’t need surgery.
GEICO insured the driver. Farmers Insurance insured a car that the pedestrian owned a California. Farmers paid almost $5,000 in Medpay benefits to his medical poviders with whom he treated.
I settled his personal injury claim with GEICO for $65,000.
But the battle wasn’t over. As expected, Farmers asked me to repay them for the Medpay benefits that they paid.
I told Farmers I’d repay them minus my pro-rata attorney’s fees and costs. Farmers agreed.
Thus, I paid Farmers a little under $3,300. This resulted in a savings of about $1,600 for my client!
Without an attorney, my client wouldn’t have received a pro-rate reduction of attorney’s fees and costs. This is just one of my many car accident settlements where my client’s saved money by having an attorney.
Learn more about claims for California residents who are injured in Florida car accidents.
Which States Require You to Repay Mepday from a Car Accident Settlement?
States that require the injured person to repay the Medpay auto insurer are:
- Georgia (but the Mepday insurer must reduce by attorney’s fees and costs, and injured person must have been made whole) O.C.G.A. § 33-24-56.1(b)
- Illinois (but must reduce by attorneys fees and costs) Manago ex rel. Pritchett v. County of Cook, 2016 IL App (1st) 121365
- Oregon (but only if the total PIP payments are greater than the damages suffered by the person. (Oregon Statute 752.544)
Therefore, if a car insurance policy (from one of those states) pays Medpay benefits for a Florida car accident, the above laws determine payment.
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Editor’s Note: This post was originally published on March 2013 and has been completely reviewed for its accuracy.