Medical Payments Coverage, known as Med Pay for short, is a type of optional car insurance in California that covers medical bills and funeral expenses for you and your passengers, regardless of who is at fault for an accident.
Other advantages of Med Pay insurance include that you and your family members can also claim damages (up to policy limits) if you or they are:
- Hit by a vehicle as a pedestrian,
- Injured while a passenger in someone else’s car, or
- Injured while taking public transportation. 1
The following chart compares Med Pay to standard automobile liability insurance:
| Med Pay | Liability Insurance | |
| Purpose | Covers medical expenses for you and your passengers | Covers bodily injury and property damage to others |
| Fault | Pays regardless of fault | Only pays if you are at fault |
| Requirement | Optional | Mandatory |
| Minimum coverage | $1,000 | $15,000 for bodily injury per person, $30,000 per accident for bodily injury, $5,000 for property damage |
| Deductable | No | Yes |
To help you better understand Med Pay insurance, our California personal injury lawyers discuss, below:
- 1. What is Med Pay?
- 2. Benefits
- 3. Do I need it?
- 4. Will my premiums go up?
- 5. What if I have health insurance?
- 6. Made Whole Doctrine
- 7. Policy Limits
- Additional Reading
Med Pay pays regardless of fault.
1. What is Med Pay?
“Med Pay” is short for “medical payments coverage.” In California, it is optional first-party insurance that you can elect to add to your auto policy.
Med Pay covers reasonable and necessary bills when you or your family is injured in an accident involving a vehicle, regardless of who is at fault.
Examples of when Med Pay might apply include:
- You are injured in a truck accident while driving home from work;
- You suffer a spinal injury when you are injured in an accident while taking Uber;
- A passenger on your motorcycle suffers a head injury after a car accident;
- Your child suffers a wrongful death in a bicycle accident;
- Your spouse is injured in a “pedestrian knockdown.”
2. Benefits
Payments made under Med Pay are made directly to a doctor or hospital. There is no need to pay most expenses out of pocket and submit the bills for Med Pay reimbursement or to wait while the insurer investigates the accident, even if you were at fault.
Other advantages of Med Pay include:
- No deductibles or co-pays;
- No restriction on the type of provider you can visit;
- Covers both you and your immediate family when:
- You are a passenger in someone else’s vehicle;
- You are a pedestrian hit by a vehicle, or
- You are injured while on public transportation.
What expenses are reimbursed?
Med Pay covers (or reimburses) all reasonable and necessary medical bills and/or funeral expenses up to the policy limits. Such expenses can include (without limitation):
- Doctor’s bills;
- Hospital bills;
- Ambulance and EMT bills;
- Chiropractor or acupuncture bills;
- Physical or occupational therapy;
- X-rays and MRIs;
- Short- or long-term care (including home health care);
- Medical equipment (such as crutches);
- Prosthetics; and
- Dentist’s bills to fix broken teeth.
What expenses are not covered?
California medical payments insurance does not cover:
- Car repair bills;
- Costs of property damage to fences, gates, etc.;
- Coverage in excess of policy limits;
- Expenses not related to the accident; or
- Accidents not involving a vehicle (for example, horseback riding accidents).
3. Do I need it?
Med Pay insurance is particularly good if you have no health insurance or if your insurance has high deductibles or co-pays.
Though even if you have good health insurance, you may wish to purchase Med Pay. Med Pay also covers passengers in your vehicle, whether or not they have health insurance.
Plus unlike many health plans, it has no limit on the types of services or providers you can use.
Finally, Med Pay coverage is “per incident,” not per year. So there are no yearly caps such as are found in many policies of health insurance.
You are advised to carry Med Pay if you can afford it.
4. Will my premiums go up?
In California, an insurer cannot raise rates when you make a claim and were not at fault.2
If you were at fault, it is up to the insurer whether to raise your rates.
5. What if I have health insurance?
Med Pay may be preferable to your health insurance if you have not yet met the yearly deductible or when you have large co-pays.
Note that Med Pay insurance is “per incident.” This means it will not affect any yearly or lifetime cap on payments you might have under your health insurance policy.
What if I can get a medical lien?
Some doctors and facilities may accept a medical lien following an accident. A lien is a legally binding contract that allows the provider to get paid from any judgment or settlement you get from a third party.
Not all providers are willing to accept a medical lien instead of insurance or cash. Plus you are still responsible to pay the bills if the final disposition is not in your favor.
This makes using Med Pay preferable to a medical lien in most situations.
Do I have to tell my insurer about accidents?
If you were at fault for an accident and the other party was not injured (or injured only slightly), you may be tempted not to put a claim through your auto insurer.
Though California law requires you to report an accident to the DMV if anyone was injured (no matter how minor).3 Most insurance policies also have a similar requirement.
You may wish to read our article, 15 Steps to Take After a Car Accident in California.
Med Pay policies start at $1,000
6. Made Whole Doctrine
Most Med Pay policies give the insurer a right to reimbursement. This is to prevent you from recovering money for medical bills from a third party and pocketing it instead of reimbursing your auto insurer.
However, most California Med Pay coverage is subject to California’s “Made Whole” rule. Under this rule, you must be “made whole” for your damages from the accident before having to repay your auto insurer a dime.4
Note that some health insurance policies provide explicitly that the “made whole” rule does not apply.5 For example, such a provision may state:
“Health Plan shall be entitled reimbursement regardless of whether the total amount of the recovery of the insured on account of an injury or illness is less than the actual loss suffered by the insured. The proceeds of any judgment or settlement obtained by Health Plan or the insured shall first be applied to satisfy Health Plan’s claims, liens, and other rights.”6
An experienced California injury lawyer can read through your insurance policy and help you negotiate a settlement that will leave you something left over for your out-of-pocket expenses and pain and suffering.
7. Policy Limits
By law, all companies selling motor vehicle insurance in California must offer optional Med Pay coverage with policy limits of at least $1,000.
Most insurers offer higher limits as well — typically $2,000, $5,000, $10,000 and $25,000.7
Some large insurers such as State Farm offer Med Pay coverage of up to $100,000. How much you should purchase depends on your budget and what other types of insurance you have.
Additional Reading
For more information, refer to our related articles:
- How to get “Medical Bills” paid after a California accident – Your options for paying for your doctor’s bills and medical expenses.
- California Doesn’t Have PIP Insurance – Here’s Why – Explains why California does not offer personal injury protection insurance.
- “Subrogation” in California Personal Injury Claims – How It Works – Overview on how subrogation works in California.
- A Guide to “Bodily Injury Liability” Insurance in California – What you need to know about how bodily injury liability insurance operates.
- “Uninsured Motorist” Coverage in California – How It Works – What UM/UIM insurance is and why you should have it.
Legal references:
- Nager v. Allstate Ins. Co. (2000) 83 Cal.App.4th 284, 290.
- California Insurance Code 491.
- California Vehicle Code 16000 VC.
- 21st Century Insurance Company v. Superior Court (Quintana) (2009) 47 Cal. 4th 511.
- Samura v. Kaiser Foundation Health Plan, Inc. (1993) 17 Cal.App.4th 1284.
- This clause is an edited version of the one upheld in Samura v. Kaiser, note 5.
- See, e.g., Value Penguin, Medical Payments Coverage.