Car Insurance Medical Coverage Limitations

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 16, 2021

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In the event of an injury caused by a car accident, your car insurance medical coverage will determine how much your insurance company will pay for accident-related medical bills. Medical coverage on your car insurance will pay for injuries to you, or passengers in your car, after a car accident up to the limits set in your auto insurance policy.

Dollar Limits on Medical Car Insurance Coverage

Look in your policy for a section called Limits of Liability. This is the place that spells out the rules on how much your insurance company will pay for your medical claim. If your medical insurance coverage, which appears on the declarations page that accompanies your policy, is $5,000, that is the total amount your insurer will pay for each injured person in your car who has been involved in the same accident.

TIP: You will be given an option to set your medical car insurance coverage limits. Typically, coverage ranges from $1,000 to $10,000 per person, but it can be as high as $25,000 per person or more depending on how much you want to pay for this coverage.

If the same injured person is making a medical insurance claim, and either a liability claim or an uninsured motorist claim on the same policy, any money paid for medical expenses under liability or uninsured motorist will be deducted from the medical claim before the expenses are paid. In other words, no double dipping!

What Your Insurance Company Will Pay For

Your insurance company will only pay for medical treatment that your policy covers. A typical car insurance policy will only pay for “reasonable expenses” and “necessary medical treatment.” If the insurance company does not feel your medical treatment is within the guidelines set by the policy, they can dispute your claim and not agree to pay for your medical expenses. In the event the insurance company disputes a particular medical treatment, the claims adjuster will tell you to have a physical exam with the insurance company’s own doctor in order to verify your need for the treatment.

KEEP IN MIND: If you refuse to get a medical exam at the insurance company’s request, the company can refuse to pay for the treatment

Medical Expenses Your Car Insurance WILL NOT Pay For

Any insurance policy will contain a list of situations when your medical payments coverage does not apply. The more common exclusions that come into play include:

  • Injuries sustained while operating your car to transport people for a charge (such as a taxi or shuttle service)
  • Injuries sustained while residing in the vehicle (commonly applicable to motor homes)
  • Injuries on vehicles with less than four wheels
  • Injuries sustained in a commercial vehicle such as a taxi
  • Injuries sustained during the course of employment, and the injuries are covered by workers compensation
  • Injuries caused by war, nuclear reaction, radiation, or radioactive contamination
  • Injuries sustained while operating a vehicle in a race or speed contest

TIP: Exclusions can change across policies. When shopping for policies, be aware of the exclusions to med pay coverage before you make a purchase.

Car Insurance Medical Coverage Dispute

If you dispute what is covered under your medical pay coverage in your auto insurance policy, you have the right to request a neutral arbitrator to settle the disagreement between you and your insurance company. The insurance company also has a right to request arbitration.

The neutral arbitrator will review the nature of the disagreement, the terms of the insurance policy, and the medical treatment being disputed and make a decision favoring one party or the other. The arbitrator cannot change the terms of your med pay in your insurance coverage, but can decide whether or not the treatment you include in your claim falls within those terms. Both parties will be bound to the arbitrator’s decision, you cannot file a lawsuit for coverage after having the matter settled by arbitration.

Arbitration, although generally cheaper and faster than litigation, is not without cost. If you cannot agree up front who pays for the arbitration, the cost will be split, and you will pay your proportional share of attorney fees and any other expenses you incur to help your case. If your dispute proceeds to arbitration, it is helpful to solicit the advice of an experienced car accident attorney prior to settling the dispute.

Payment Under Medical Insurance

The insurance company may pay you, whoever is responsible for paying your bills, or the medical provider directly, whichever they choose. You don’t have a choice in the matter

Medical insurance coverage is available on any auto insurance policy, and can vary in scope depending on how much you wish to pay for it. Click here to visit the Free Advice quote center to see how much medical coverage will cost in your policy.

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