The medical payments claim is made against either Personal Injury Protection (PIP) or Medical Payments (MedPay) policy coverages. The type and limits of coverage for medical expenses is determined by the state in which you live and the amount of insurance purchased. States are classified as no fault or fault.
In no fault insurance states you will claim reimbursement from your own insurance company. In fault insurance states you file claims against the insurance company of the person at fault, but you can also file a claim with your own insurance company.
Insurance Medical Forms First and Itemization Second
When you need to make a medical payments claim the first step is to contact the insurance company and request the correct filing forms. The insurance company will tell you which company to file a claim with based on the terms of the policy. You want to be sure you understand which specific expenses will be covered to make sure you claim all that are allowable. Insurance policies in general will cover all necessary medically related expenses.
Normally you must pay the MedPay covered expenses first and then claim reimbursement from the insurance company. MedPay coverage will have maximum limits too which in many cases is $25,000.
You may need to use your private health insurance if the PIP or MedPay coverages do not pay the full bill. You should first file against your auto insurance as primary coverage and make the private health insurance policy secondary. PIP may have a deductible, but it will also cover more expenses than MedPay like lost income or daycare expenses. MedPay is for medical expenses only.
Covered Medical Expenses
Medical expenses will cover the auto driver, passengers and pedestrians. Eligible expenses include hospital stays, surgical procedures and dental treatments. It also pays for ambulance services; ancillary services like x-rays or MRIs; prosthetic devices; nursing care; emergency medical treatment; and medical supplies.
PIP covers the medical expenses just mentioned plus physical therapy; occupational rehabilitation; psychiatric care; lost wages; and many other expenses.
Submit your claim to the insurance company, but do not sign anything that bars you from filing future claims. Some injuries are not apparent at the time of the accident and can appear at a later date. There are also incidences where an injury leads to complications that could not be anticipated.
File PIP or MedPay claims for everyone in your car at the time of the accident who receives medical care. If the insurance company balks at paying the claims and requests that their doctor perform medical examinations, it is important to contact an attorney at that point if you have not already done so.
