What Is Medical Payments Coverage?
NO-FAULT Coverage = Doesn't Matter Who Caused the Accident
Medical Payments (Med Pay) covers medical expenses for you, family members, and passengers - regardless of who's at fault. It's "first-party" coverage that pays YOUR medical bills.
Key Difference from Liability:
Liability (Part A) pays for injuries to others when you're at fault. Medical Payments (Part B) pays for injuries to you and your passengers regardless of fault.
What Medical Payments Covers:
Who Is Covered Under Part B?
First: What is a "Family Member"?
In the PAP, "family member" means a person related to you by blood, marriage, or adoption who is a resident of your household.
1. You and Family Members
While occupying a motor vehicle (remember: "occupying" = in, on, getting in/out)
OR when struck by a motor vehicle or trailer as a pedestrian
2. Any Other Person
While occupying your covered auto
Example: A friend riding in your car is covered even if they have no insurance.
Pedestrian Coverage
If you or a "family member" is walking and gets hit by a car, your Med Pay coverage applies.
WAIT - Who counts as a "Family Member"?
In insurance, "family member" has a very specific meaning:
- + A person related to you by blood, marriage, or adoption
- + Who is a resident of your household (lives with you!)
COVERED - Family Member
The Setup: You live in Newark, NJ with your spouse and your 19-year-old son who still lives at home.
What Happens: Your son is walking to the store and gets hit by a car.
Result: YOUR Med Pay covers his medical bills. He's related to you AND lives in your household = family member.
NOT COVERED - Not a Family Member
The Setup: You live in Newark, NJ. Your cousin lives in Alabama.
What Happens: Your cousin is walking in Alabama and gets hit by a car.
Result: YOUR Med Pay does NOT cover him. He's related but does NOT live with you = not a "family member" under your policy.
Critical Time Requirement
3 Years
From the Date of the Accident
Medical expenses must be incurred within 3 years of the date of the accident to be covered.
Example: Accident on January 1, 2024. Medical expenses incurred up to December 31, 2026 are covered. Expenses after that? Not covered.
Medical Payments Exclusions
Medical Payments will NOT pay for:
Public/Livery Conveyance
Using covered auto as taxi, rideshare, etc.
Auto Business
While working in the auto business (doesn't apply to your own covered auto)
Vehicles with Fewer than 4 Wheels
Motorcycles, ATVs, etc.
Vehicles for Off-Road Use
Designed mainly for use off public roads
Vehicle Used Without Permission
Using a vehicle without reasonable belief of permission
Racing Facility
Racing, speed contests, or practicing for such events
Vehicle Available for Regular Use
Occupying a vehicle available for regular use not listed on policy
Workers Compensation
Injuries covered by workers comp or similar law
Nuclear Energy Liability Policy
Person insured under nuclear energy policy
Limits of Liability
Per Person Limit
The limit shown in the declarations is the maximum per person for each accident.
Coverage Applies Per Person:
If your limit is $5,000 and 3 people are injured, each person can receive up to $5,000.
No Duplicate Payments:
No one will receive duplicate payments for the same elements of loss.
Other Insurance
If Other Insurance Applies:
The insurer pays its proportionate share based on the ratio of its limit to all available limits.
For Nonowned Vehicles:
Medical Payments coverage is EXCESS over any other collectible auto insurance providing payments for medical expenses.
Example: You're injured while riding in a friend's car. Their Med Pay pays first; yours only pays if their limit is exhausted.
Exam Trap Alerts
3 years: Medical expenses must be incurred within 3 years of the accident date.
No-fault: Med Pay doesn't care who caused the accident - it pays regardless.
Pedestrian coverage: You and family members are covered if hit as pedestrians!
Limit is per person: Not per accident like liability.
Excess for nonowned: Your Med Pay is secondary when riding in someone else's car.