Medical payments coverage: the no-fault medical limit for injured passengers in your van

What MedPay pays, and for whom

Medical payments coverage is a small, first-party medical fund attached to your auto policy, usually sold as an optional line when you buy NEMT insurance. It pays the injured person’s reasonable medical bills after an accident in or around a covered van, and it pays without anyone having to prove the driver did something wrong. The Texas Department of Insurance sums it up in one line: it pays your medical bills and your passengers’. Personal injury protection works differently in no-fault states; see does PIP cover passengers.

The ISO endorsement Virginia insurers use (CA 22 46) shows how the wording reads on a commercial policy:

• Who is covered. Any person injured while occupying a covered auto, plus the named insured and family members in other situations. For a company policy, the first group is the one that matters: your riders, escorts, and attendants.
• What counts as occupying. Being inside or on the van, and also the act of climbing in or stepping out. Boarding by ramp or lift fits that wording.
• What it pays. Hospital and doctor bills, X-rays, dental and surgical care, nursing, chiropractic care, prosthetics and rehabilitation, ambulance charges, and funeral expenses, as long as each is reasonable and necessary.
• The time limit. Expenses incurred within three years after the accident. The same endorsement offers a separate income loss benefit, sold as its own coverage.
• The main exclusion. Injuries to the extent workers’ compensation or a similar law pays them, which is why an injured employee driver normally goes through workers’ compensation for NEMT instead.

Other states’ endorsements use different numbers and lists, so read the one attached to your policy.

Why it matters when a rider is hurt boarding

A liability claim needs fault. MedPay does not. When a rider slips on a ramp or bumps a head getting into the van, the rider’s medical bills can be paid from MedPay without the rider first proving your driver was careless, up to the amount set for each person. The liability coverage still answers any claim for pain, lost income, or bills above that limit, and the passenger injury claim guide covers how those claims unfold.

The business auto form keeps the two from paying twice: a medical bill MedPay has already covered cannot be collected again under the liability coverage of the same policy.

General liability policies carry their own medical payments section, but the standard form’s auto exclusion counts loading and unloading as using the van, so a boarding fall usually lands back on the auto policy. General liability insurance for NEMT explains where that exclusion stops.

MedPay, PIP, and liability side by side

The three coverages answer different questions, which is why a fleet policy often carries more than one.

Personal injury protection pays for more kinds of loss. In Texas, the insurance department explains, PIP also covers lost wages and other nonmedical costs, and it comes on every auto policy unless the insured turns it down in writing. Fleets in no-fault states see this on the declarations page as symbol 5, the ISO code for vans the company owns that state law requires to carry no-fault benefits. How PIP and no-fault insurers handle bills for rides themselves is in billing auto insurance for medical transportation.

Limits and who pays first

State law sets the floor in some places, and two states show how differently it can work:

• Virginia. On request, insurers must provide medical expense benefits of $2,000 per person, or another limit the insured and insurer agree on (Code of Virginia 38.2-2201).
• Pennsylvania. Every policy must include a $5,000 medical benefit, and insurers must make medical benefits of up to at least $100,000 available (75 Pa.C.S. 1711 and 1715).

In some states the auto coverage pays ahead of the rider’s own health plan. Pennsylvania makes its auto medical benefits primary over health plans and similar arrangements, except workers’ compensation (75 Pa.C.S. 1719). Federal Medicare rules define no-fault insurance to include coverage sometimes called medical payments coverage or personal injury protection, and Medicare stays secondary for whatever that insurance covers or ought to cover (42 CFR 411.50 and 411.20). For a rider on Medicare, the bills go to your auto insurer first.

Handling a MedPay claim

1. Report the injury to your insurer the same day. The Virginia endorsement requires written notice as soon as possible, with enough detail to identify the injured person, the time, the place, and what happened.
2. Give the rider the claim number. The injured person, or someone on their behalf, sends written proof of claim with details of the injuries and treatment.
3. Expect requests for records. The insurer can ask the injured person to sign authorizations for medical reports and to attend medical exams at the insurer’s expense.
4. Keep your own file. The incident report, the driver’s statement, and the trip record showing who was aboard belong together. The incident report template lays out the fields.