Medical Payments Coverage

Medical payments coverage, usually called MedPay, pays reasonable medical expenses for you and your passengers after a crash, without regard to who caused it. California is an at-fault state and does not sell personal injury protection, so MedPay is the closest thing a California policy carries.

Two features make it useful out of proportion to its size. It pays regardless of fault, so it does not wait for anyone to accept liability. And it carries no deductible, unlike collision and comprehensive, so the first dollar of treatment is reachable.

It generally follows the person rather than only the car. Most forms reach you and your passengers in your own vehicle, you in someone else's vehicle, and you as a pedestrian struck by one. Which of those your policy reaches, and at what limit, is on your declarations page.

How does it sit against your health insurance?

Alongside it rather than instead of it. MedPay is often used for the costs a health plan leaves behind, including the deductible and copays, and for treatment in the weeks before a health plan or a liability settlement produces anything.

Limits are usually modest and are chosen when the policy is written. Because the coverage is inexpensive relative to what a single emergency visit costs, the limit is worth looking at rather than leaving at whatever was selected years ago.

How does it interact with an uninsured motorist claim?

Directly, and this catches people out. Insurance Code 11580.2 permits a policy to provide that what you recover under uninsured motorist coverage is reduced by the amounts paid or due to be paid under your medical payments coverage.

So the two coordinate rather than stack. MedPay gets money to the providers early; the uninsured motorist limit is then measured net of it. That is a reason to hold a meaningful uninsured motorist limit rather than treating MedPay as a substitute for one.

Do you have to pay it back?

Sometimes, and California limits when. Most policies contain a reimbursement condition: if you later recover from the driver who caused the crash, the insurer may ask to be repaid out of that recovery.

California courts apply the made-whole rule to those demands, so an insurer is generally not entitled to reimbursement until the insured has been made whole for the loss. The California Supreme Court has also held that attorney fees and pro rata litigation costs are not deducted from the total recovery when deciding whether that point has been reached.

A personal injury claim is not assignable in this state, so the insurer cannot pursue the at-fault driver directly for what it paid. It has to wait for your recovery and then ask. Whether a particular demand is owed, and how much, turns on your policy wording and the facts, and belongs with an attorney rather than with us.

Statutes and case law in this area are revisited periodically. The provisions described above reflect the Insurance Code and reported California decisions as published when this page was written.

MedPay is one of the smaller lines on a premium and one of the first to matter after a crash, because it does not wait for a fault decision. We can show you what raising the limit costs and how it would sit against your health plan's deductible.