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Med Pay After A Car Accident – Durham Car Accident Attorney


Med Pay, short for medical payments coverage, is a popular add-on to many North Carolina car insurance policies. If available, these funds can be obtained early in a personal injury case and long before a settlement is contemplated.

Med pay covers “injuries sustained on the property or premises of the insured, or in the use occupancy, or operation of an automobile, regardless of who may have been responsible for causing the accident.” 42 C.F.R. § 411.50(b). Essentially, the availability of med pay is based more so on the location of the injury, rather than the cause.

Determining the availability of med pay is two-fold:

  • First, you will need a copy of the insurance policy providing coverage for the car in which you were a passenger or driver in the car accident. Once a copy has been acquired, direct your attention to the coverage limits. If med pay is available, it will be listed with the bodily injury and property damage lines. Typically, the amount available will be between one and five thousand dollars.
  • Second, the coverage is only provided for out-of-pocket medical expenses. If you were examined in the hospital or needed to purchase prescription medication, med pay will reimburse those expenses. To get the med pay, you or your attorney must set up a separate “med pay” claim with the insurance company providing coverage. Medical bills and related records, if appropriate, are then transmitted for the adjuster’s review and for reimbursement related to your Durham car accident. If you did not incur medical expenses, med pay will not be paid to you.

Once you have determined that med pay is available and completed an appropriate request, a med paycheck with an explanation of benefits, or exhaustion letter, will be sent to you through the mail. Med pay is paid in an amount up to the limit stated in the policy and is considered “exhausted” after the stated amount is paid.

Other things you should know about Med Pay:

  • Med pay is considered “quasi-health insurance,” “first party”, and “primary insurance.” As such, Medicaid and Medicare are entitled to receive up to 100% of the med pay coverage, based on their own expenditures.
  • Chiropractors routinely request, and receive, med pay from insurance providers. The average health insurance policy does not provide for chiropractic care; therefore, med pay coverage becomes primary insurance.

Attorneys charge a flat fee for requesting and disbursing med pay. The North Carolina State Bar’s Rules of Professional Conduct (Rule 35) does not allow the collection of a contingent fee on amounts recovered through med pay. Therefore, the assistance your attorney gives for requesting and disbursing med pay will be the single flat fee payment, and no future payments will be due for this kind of assistance.

If you have medical expenses related to a car accident, contact a Durham Attorney at Wallace Pierce Law. Waiting for a settlement can be a long process, Wallace Pierce Law can help identify and request med pay coverage to get money upfront for your out of pocket medical expenses. Call Wallace Pierce Law today at (919) 887-7892 today for a free consultation to discuss your options.

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