Medical Payments Insurance Coverage in Texas

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Medpay Insurance

IN TEXAS, MEDICAL PAYMENTS INSURANCE COVERAGE (Medpay) IS AVAILABLE IN AUTO INSURANCE POLICIES.

Medical Payments Insurance Coverage, also known as Medpay Insurance, is a type of insurance that is sometimes offered by auto insurance companies to “replace” PIP in car accident injury cases. Unfortunately, the coverage is not as comprehensive as PIP. Medical Payments coverage is typically sold with a limit of $2500.00. It only covers medical bills from the past. If you have a liability claim, it is also collectible against the other person’s liability insurance. This means it will have an impact on your settlement negotiations with the at-fault party’s insurance company because your insurance company will try to collect against your settlement and get involved in the negotiations in order to recoup the money paid. This can make negotiating with the other party more difficult.

PIP stands for Personal Injury Protection, and your liability insurance company is supposed to provide you with this coverage when you purchase your policy. You may refuse it if you so desire, but it must be offered. If an insurance company asserts that you do not have PIP, they must have a written rejection (showing you were offered but signed the rejection instead). There is coverage if the insurance company does not have a written rejection.

Call the Dallas car wreck attorneys at Law Office of Doug Goyen at (972) 599 4100 if you need help with a car crash injury case. 

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EXAMPLE OF MEDICAL PAYMENTS COVERAGE IN A TEXAS AUTOMOBILE INSURANCE POLICY

MEDICAL PAYMENTS COVERAGE

INSURING AGREEMENT

A. We will pay reasonable expenses incurred for necessary medical and funeral services because of bodily injury: 

1. Caused by an accident; and 

2. Sustained by a covered person. 

We will pay only those expenses incurred within three years from the date of the accident. 

B. Covered person as used in this Part means: 

1. You or any family member; 

a. while occupying; or 

b. when struck by; 

a motor vehicle designed for use mainly on public roads or a trailer of any type. 

EXCLUSIONS

We do not provide Medical Payments Coverage for any person for bodily injury: 

1. Sustained while occupying any motorized vehicle having fewer than four wheels. 

2. Sustained while occupying your covered auto when it is: 

a. being used to carry persons for a fee: this does not apply to a share-the-expense carpool; or 

b. being used to carry property for a fee; this does not apply to you or any family member unless the primary usage of the vehicle is to carry property for a fee; or 

c. rented or leased to another, this does not apply if your or any family member lends your covered auto to another for reimbursement or operating expenses only. 

3. Sustained while occupying any vehicle located for use as a residence or premises. 

4. Occurring during the course of employment if workers’ compensation benefits are required or available for the bodily injury. 

5. Sustained while occupying or, when struck by, any vehicle (other than your covered auto) which is: 

a. owned by you; or 

b. furnished or available for your regular use. 

6. Sustained while occupying or, when struck by, any vehicle (other than your covered auto) which is: 

a. owned by any family member; 

b. furnished or available for the regular use of any family member. 

However, this exclusion (6) does not apply to you. 

7. Sustained while occupying a vehicle without a reasonable belief that that person is entitled to do so. This exclusion (7) does not apply to you or any family member while using your covered auto. 

8. Sustained while occupying a vehicle when it is being used in the business or occupation of a covered person. This exclusion (8) does not apply to bodily injury sustained while occupying a: 

a. private passenger auto; 

b. pickup or van that you own; or 

c. trailer used with a vehicle described in 8.a. or 8.b. above. 

9. Caused by or as a consequence of: 

a. discharge of a nuclear weapon (even if accidental); 

b. war (declared or undeclared); 

c. civil war; 

d. insurrection; or 

e. rebellion or revolution. 

10. From or as a consequence of the following whether controlled or uncontrolled or however caused: 

a. nuclear reaction; 

b. radiation; or 

c. radioactive contamination. 

LIMIT OF LIABILITY

A. The limit of liability shown in the Declarations for this coverage is our maximum limit of liability for each person injured in any one accident. This is the most we will pay regardless of the number of: 

1. Covered persons; 

2. Claims made; 

3. Vehicles or premiums shown in the Declarations; or 

4. Vehicles involved in the accident. 

B. Any amounts otherwise payable for expenses under this coverage shall be reduced by any amounts paid or payable for the same expense under any Auto Liability or Uninsured/Underinsured Motorists Coverage provided by this policy. 

C. No payment will be made unless the injured person or that person’s legal representative agrees in writing that any payment shall be applied toward any settlement or judgment that person receives under any Auto Liability or Uninsured/Underinsured Motorist Coverage provided by this policy. 

OTHER INSURANCE

If there is other applicable auto medical payments insurance we will pay only our share of the loss. Our share is the proportion that our limit of liability bears to the total of all applicable limits. However, any insurance we provide with respect to a vehicle you do not own shall be excess over any other collectible auto insurance providing payments for medical or funeral expenses. 

ASSIGNMENT OF BENEFITS

Payment for medical expenses will be paid directly to a physical or other health care provider if we receive a written assignment signed by the covered person to whom such benefits are payable.”

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