Medical & Wage Benefits
Are Medical & Wage Benefits Covered Under My Automobile Insurance Policy?
Medical bills can be paid by different means. If you have Medical Payments ("Med Pay”) coverage under your auto policy, your insurance company may pay your medical costs, whether you were at fault or not in the accident. These benefits are often included on automobile policies, but generally not on motorcycle policies.
An injured person may be able to collect Med Pay benefits from the insurance policy that covers the automobile they were traveling in, or in the case of a pedestrian, the automobile they were struck by. In other cases, the injured person might receive Med Pay benefits from the insurance policy that covers their insured's automobile or an insured automobile of any member of their household.
It is important to find out soon after an accident exactly what types of benefits are available. There is no penalty for making a claim for Med Pay benefits. However, in most cases the insurance company who makes payments under Med Pay coverage will be entitled to reimbursement from the negligent party's insurance carrier.
What Medical Expenses Are Covered?
Med Pay benefits usually cover all reasonable and necessary medical bills incurred as a result of accident related injuries. These may include bills from doctors, hospitals, ambulances, physical therapists, chiropractors and prescriptions.
There is always a dollar limit or time limit on how much Med Pay insurance will cover. In addition, some policies have a deductible of up to $250. Send your medical bills to the Med Pay carrier, not the negligent party's insurance carrier. Until the claim is settled, that carrier is not under any obligation to pay anything.
What Wage Loss Is Covered?
Some policies will reimburse a portion of your lost wages. Typically, it is necessary for you to be off work for a period of time, often 14 days. Once this time has elapsed, you may be paid your wage loss until the maximum time period provided by the insurance policy. That maximum coverage period is frequently one year. Whether you receive payment for the initial waiting period depends upon state law and the policy terms.
What about My Losses Not Paid by Med Pay?
If there are no Med Pay benefits available, or your bills exceed the amount of your coverage, health insurance may be used to pay at least part of your medical bills. Other sources such as Medicare and Welfare, or a disability policy through your employer, may pay medical bills. In any event, all actual medical expenses and wage loss will be included at the time of settlement, even if you had no Med Pay coverage.
How Do I Apply for Benefits and What Documentation Is Needed?
There may be three types of documentation the adjuster needs to pay Med Pay benefits:
- A completed Application for Benefits form. The insurance carrier should send you this form. Fully complete, sign and return it to the insurance carrier. The form contains an authorization for release of information, which allows the insurance carrier to obtain medical bills and reports from your doctors to verify that their bills are related to the automobile accident. By signing this authorization, you do not release your rights to an injury claim.
- A doctor's note stating that you are unable to perform your job and the length of time you are released from work due to your injuries.
- A wage loss form from your employer. The adjuster needs to know your rate of pay and the number of hours a week you work in order to compute your wage loss benefits. If you are self-employed, insurance adjusters will ask to see your business records and tax returns.
Check with your insurance company or agent to determine their exact requirements. If your medical bills and wage loss remain unpaid even though you have Med Pay coverage which should apply, arbitration can often be requested. A panel of arbitrators then decides your rightful claim.