There are various types of insurance coverage, and, within each type of insurance, there are multiple different forms and levels of coverage. For instance, in a typical motor vehicle collision case, you may be dealing with liability coverage, excess coverage, medical payments coverage (Med-Pay), personal injury protection (PIP) and uninsured or underinsured coverage (UM/UIM). However, it may take several months to resolve a car accident case, especially if there is litigation. In the meantime, medical care providers are not getting paid, and the providers send the bills to collections.
Med-Pay, an optional coverage in North Carolina and South Carolina, can ensure that the reasonable and necessary accident-related medical expenses of all passengers in your vehicle are paid immediately, regardless of who was at fault for the accident. Your medical payments coverage moves with you (walking, riding with a friend or on public transportation, in-state or out), as well as with your insured vehicles, regardless of who’s driving. It carries no deductible or co-pay. Your health insurance coverage for some or all of your bills does not affect Med-Pay. However, Med-Pay will not apply to a person who is injured during employment when workers’ compensation should apply. Also, the policy limits of Med-Pay coverage are typically low – $1,000.00 to $10,000.00, so often it is insufficient to cover all of the medical expenses.
There is no subrogation with Med-Pay, so you do not have to pay it back if you ultimately recover from the third-party driver who was at fault. On September 26, 1978, the North Carolina Department of Insurance (NCDOI) adopted a general anti-subrogation rule stating that “Life or accident and health insurance forms shall not contain a provision allowing subrogation of benefits.” 11 N.C.A.C. 12.0319. South Carolina Code Section 38-77-144 states, in part, “If an insurer sells no-fault insurance coverage which provides personal injury protection, medical payment coverage, or economic loss coverage, the coverage shall not be assigned or subrogated and is not subject to a setoff.” However, the one exception is Medicare, which has a super priority right of recovery and a 100% lien against Med-Pay.
Since Med-Pay does not have the right to reimbursement, then those funds simply increase the settlement, without having to be reimbursed. You have to pay all the medical liens out of any settlement funds received from the third party. Outstanding balances with individual providers (i.e., ambulance, medical doctor, hospital, chiropractor) are going to be harder to negotiate. When the Med-Pay amount available is less than the amount of outstanding medical bills, it is important to think through which bills to pay, and use Med-Pay for the ones that will be the most difficult to negotiate.
Like MedPay, PIP will cover the medical expenses, but PIP insurance can cover more than just medical expenses, such as lost income. However, PIP often has a deductible and may require the consumer to pay a percentage of medical bills. Also, PIP coverage is not available in North Carolina.
Collecting a Med-Pay claim is usually very easy. These claims are paid quickly, upon submission of the proper documentation to the carrier. Typically, you just need to send a copy of the accident report and copies of your medical bills to your insurance company. You usually will not need a lawyer to help you with this claim. At Tatum Law Firm, we always help our clients collect Med-Pay coverage and do not charge any fee for this service.