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Medical Payments Coverage

Medical Payments coverage is coverage you may have on your own auto insurance policy. If you have Medical Payments coverage, it will cover some or all of your medical bills incurred as the result of a car accident. This is true whether the accident was your fault or not. Medical Payments coverage can make all the difference for you as an injured party. First, you may not have health insurance, or may have a high deductible; if so, Medical Payments coverage will pay for bills which your health insurance may not cover. Second, the Medical Payments coverage can supplement any health insurance you do have, and can help you recover co-pays and out of pocket expenses. Lastly, even if the accident is not your fault, you may not be able to recover from the at-fault driver. In that case, the Medical Payments coverage will help absorb some of the financial impact of the accident.

The Reasonableness Factor

The language of your auto insurance policy will govern what your Medical Payments coverage will pay. It’s not always as easy as simply submitting your bills to your insurance carrier. Insurance companies often limit their responsibility to reimburse only those medical treatment expenses they deem to be “Reasonable”. Our experience with handling Medical Payments claims has revealed that insurance companies will often exclude the following from reimbursement:

  • Experimental treatments which are not designed to serve a medical purpose;
  • Acupuncture
  • Purchases of equipment which not primarily designed to serve a medical purpose, such as a home gym for rehabilitation

In addition to the treatment being reasonable, the cost of the treatment must also be reasonable. It is not unusual to receive a response from an insurance carrier indicating they will cover a percentage of a chiropractor’s fees, and a refusal to reimburse for the remainder. Quite often, the insurance company will “red line” the chiropractor’s treatment notes, indicating what the insurance carrier believe to be unreasonable treatment. Similarly, they may red line the chiropractor’s bill in an effort to indicate what they believe to be excessive treatment. If you have questions about chiropractic treatment, our article on Charlotte Chiropractors may help answer those questions.

Fortunately for the injured party, there is a presumption of reasonableness in North Carolina, established in N.C.G.S. Sec. 8-58.1. While an insurance company can rebut this presumption, your personal injury lawyer should be able to persuade them that making full payment on the Medical Payments reimbursement submission is preferable to facing a lawsuit over Medical Payments coverage.

Your Responsibilities

Your insurance policy typically requires some responsibilities or duties which you must uphold. You will be asked to cooperate with any investigation into the claim. You will also be asked to assist the insurer should they request medical records to substantiate the Medical Payments request. You may also be asked to sign a HIPAA release in the event your insurance provider wants to obtain medical records and billing on their own.

Speak With A Personal Injury Lawyer

If you were in a car accident, or if you were injured by a vehicle as a passenger, pedestrian or cyclist, you may be entitled to Medical Payments coverage. We recommend you consult with a personal injury lawyer today. You’ll get your questions answered and we’re happy to help. We can be reached at 704.749.7747 or you can click to request a FREE PERSONAL INJURY CONSULTATION, and we will reach out to you shortly. We know you have options. We hope you choose to Recover With Us.