Detailed answer — what MedPay covers and how it works in Maine

Medical payments coverage is an optional part of many auto insurance policies. It pays reasonable medical expenses (and sometimes funeral expenses) up to the policy limit for you, family members, and passengers injured in an auto accident — generally regardless of fault. MedPay can help cover emergency care, ambulance rides, hospital bills, x-rays, and sometimes related out-of-pocket costs such as necessary travel for treatment.

Important Maine-specific notes:

• Maine does not require insurers to include MedPay on every auto policy. Check your own policy to confirm if you have MedPay, and what the limit is.
• State consumer information about auto insurance, your rights, and how to file complaints is available from the Maine Bureau of Insurance: https://www.maine.gov/pfr/insurance/.
• If you recover money from a third party (for example, by settling with the at-fault driver), your insurer may have a right to be repaid (subrogation) for amounts it has paid under MedPay. Policies will describe how subrogation and reimbursement work.

This article provides general steps for filing a MedPay claim in Maine and practical tips to protect your health and recovery. This is educational material and not legal advice.

Step-by-step: How to make a MedPay claim

1. Get immediate medical care. Prioritize safety and health. Seek emergency treatment if needed and keep all visit records, bills, receipts, and medical reports.
2. Check your insurance documents. Find your auto policy declarations page or call your insurer to confirm whether you have Medical Payments coverage, the coverage limit, and any coverage specifics (who is covered, covered services, and time limits for claims).
3. Notify your insurer promptly. Call your insurer’s claims line to report the crash and state you want to open a MedPay claim. Give basic facts: date, location, injuries, and where treatment was given. Most policies require prompt notice; check your policy for any specific time bars.
4. Complete claim forms. The insurer will usually provide a claim form. Fill it out and attach medical records, itemized bills, proof of payment or balances due, and any police reports if available.
5. Coordinate with other coverage. If you have health insurance or were covered under another person’s auto policy at the time of the crash, MedPay rules in your policy will explain whether MedPay is primary or secondary. Inform all insurers about other coverage.
6. Keep copies and document everything. Keep copies of all forms, bills, receipts, communications, and the claim number. Record names, dates, and details of any conversations with claims representatives.
7. Follow up until resolved. If the insurer requests more documentation, provide it quickly. Ask for estimated timelines and next steps. If your claim is approved, the insurer will pay the provider or reimburse you per policy rules.

What documents and information you will need

• Auto insurance policy declarations page (shows MedPay limit if any).
• Claimant name, policy number, claim number (after you report), and contact details.
• Date, time, and location of crash; police report number if applicable.
• Names and contact information for drivers and witnesses.
• Itemized medical bills and medical records describing treatment and diagnoses.
• Receipts for out‑of‑pocket medical expenses, ambulance bills, or prescriptions.
• Health insurance explanation of benefits (EOB) if you used health insurance.

How subrogation and repayment often work

If your insurer pays MedPay and you later recover money from the at-fault driver (by settlement or judgment), the insurer may assert a subrogation or reimbursement right. That means the company can seek repayment for the amounts it paid on your behalf. Policy language governs this right — read your policy and ask your insurer to explain how subrogation is handled in your situation.

Common scenarios:

• If you receive a settlement, the insurer may be entitled to part of that settlement up to the amount it paid for your medical bills.
• Some policies allow you to keep a portion of a third-party recovery for non-economic damages (like pain and suffering), while reimbursing the insurer from economic recovery for medical bills.

What to do if the insurer denies or delays your claim

1. Ask for a written denial explaining the reason.
2. Review the policy language carefully to see whether the denial matches policy terms.
3. Gather and submit additional medical documentation or corrected information if the denial is for incomplete proof.
4. Contact the Maine Bureau of Insurance for guidance or to file a complaint: https://www.maine.gov/pfr/insurance/.
5. If you believe the denial is improper and you have significant damages, consider consulting an attorney who handles auto injury claims in Maine.

When to talk with a lawyer

Consider consulting a lawyer if:

• You have a serious or permanent injury.
• The insurer wrongfully denies coverage or delays payment without explanation.
• There is a dispute over fault and you need to preserve evidence or file a third-party claim against the at-fault driver.
• Your insurer pursues subrogation claims that you believe are incorrect or excessive.

A lawyer can explain your rights under Maine law, negotiate with insurers, and, if necessary, help you pursue recovery from the at-fault party. If you contact an attorney, bring your insurance policy, medical records, bills, and claim correspondence.

Helpful Hints

• Confirm whether your policy includes MedPay and what the dollar limit is before an accident happens.
• Seek medical care right away — untreated injuries can weaken a claim and harm your health.
• Keep a dedicated folder (digital or paper) for all crash-related documents.
• Give insurers honest, consistent statements. Avoid speculating about the cause of the crash.
• Ask your medical providers to send itemized bills and records directly to your insurer to speed payment.
• If you have health insurance, know how it coordinates with MedPay — in many cases MedPay can cover copays and deductibles that health insurance does not.
• Contact the Maine Bureau of Insurance if you have consumer questions or need to file a complaint: https://www.maine.gov/pfr/insurance/.