What Coverage Questions Usually Mean
This situation usually means there is a mismatch between what was said early in the claim process and what the written policy shows. In most cases, the written policy documents control what benefits exist. So the key question becomes: was MedPay actually purchased (and in force on the date of loss), or was it mistakenly assumed or miscommunicated?
Common Potential Sources of Payment (High-Level)
- At-fault party liability coverage (if applicable): This is the other driver’s (or responsible party’s) coverage that may pay injury damages if fault is proven.
- Uninsured/underinsured motorist coverage (if relevant): Separate coverage that may apply in certain situations when the at-fault driver has no coverage or not enough coverage.
- Medical payments coverage / similar benefits (if relevant): MedPay is generally designed to pay certain medical expenses without needing to prove fault, but only if it was actually purchased.
- Health insurance as an immediate payer: Many people use health insurance while the injury claim is pending, with reimbursement issues sometimes addressed later depending on the situation.
Information to Gather
- Declarations pages for the correct dates: The dec page is often the quickest way to confirm whether MedPay was selected and what the limit is.
- The full policy contract: The policy jacket plus all endorsements/forms for that term (sometimes MedPay is added/removed by endorsement).
- Proof of premium/payment history: If MedPay was purchased, there is usually a premium line item or rating detail that supports it.
- Any binder or “evidence of insurance” documents: These can help confirm what was represented at the start of the policy term (though they still may not override the final issued policy).
- Claim communications: Notes or letters showing who reported MedPay and what exactly was said (helpful for sorting out whether it was a simple intake/adjuster coding error).
Common Coverage Disputes and Practical Next Steps
- Simple reporting or coding error: Sometimes MedPay is “checked” on a claim intake screen even though it is not on the policy. A written coverage position from the insurer (confirming no MedPay for that term) usually resolves this.
- Wrong policy term or wrong vehicle: MedPay can vary by renewal term or vehicle. Confirm the exact policy period and the vehicle listed on the declarations page for the date of loss.
- Endorsement confusion: MedPay can be added or removed mid-term by endorsement. Ask for the endorsement schedule and the actual endorsement documents.
- “Should have been purchased” issues: If the insured believes they requested MedPay but it is missing, the dispute may shift away from the injury claim and toward a separate issue about procurement/documentation. That is fact-specific and may require a closer legal review.
- Do not rely on verbal assurances alone: In practice, coverage disputes are usually decided by the written policy language and the issued documents, not by informal statements made early in the claim.
How This Applies
Apply to the facts: Here, the carrier reviewed the auto policy connected to the injury claim and told the law firm that MedPay is not listed. That typically means MedPay benefits are not available under that policy term unless additional documents (like endorsements, a binder, or corrected declarations) show MedPay was actually added and paid for. The immediate, practical move is to request the complete policy packet for the correct dates and confirm in writing the carrier’s coverage position so the claim can proceed without assuming MedPay funds exist.
What the Statutes Say (Optional)
- N.C. Gen. Stat. § 20-279.21 (Motor Vehicle Safety and Financial Responsibility Act) – Defines required parts of a motor vehicle liability policy (like liability/UM/UIM rules) and recognizes that policies may also include additional, optional coverages beyond what the Act requires.
Conclusion
If MedPay was “reported” but the declarations page shows it was never purchased, the insurer will usually deny MedPay because the written policy controls. The most productive next step is to obtain the full policy for the correct term (including endorsements) and get a clear written coverage position so everyone evaluates the injury claim using the right set of available coverages. If the insured believes MedPay was requested but omitted, that may require a separate, fact-specific review.
