Medical Payments Coverage

Medical Payments coverage is designed to pay medical expenses regardless of fault. This means that if you are injured in an automobile accident or premises liability you may be entitled to have your FULL medical expenses paid regardless of who was at fault for the injury.

Full medical expenses are the full value of the charges you have incurred from the health care providers that treated you for the injury.  This is almost always a higher value than “out of pocket” medical expenses.  Often times insurance companies will offer to pay for only the “out of pocket” medical expenses. Many people do not realize that the out of pocket expenses are discounted and the insurance company is pocketing the difference between the full value of the charges you incurred and the amount you have paid out of pocket.

In Samsel v. Allstate Insurance Co., 204 Ariz. 1 59 P.3d (2002), the Arizona Supreme Court reaffirmed Arizona law that the term “incur” means “to become liable for” and is not limited to the amount actually paid for medical treatment. The Court stated:

The primary definition of the word “incur” is “to become liable for”․ Obviously, plaintiff became liable for her medical expenses when she accepted medical treatment.   The fact that plaintiff had contracted with a health insurance company to compensate her for her medical expenses, or to pay directly the health care provider on her behalf, does not alter the fact that she was obligated to pay those expenses.

This means that an insurance company is obligated to pay full incurred charges under the medical payments provision of an insurance policy regardless of the amount of money your health insurance company paid to the provider.

Keep this in mind if you have sustained an injury and an insurance adjuster calls to offer you a quick settlement for you out of pocket expenses because you may be entitled to substantially more compensation depending on the facts of your particular case.

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