How to Claim Medical Payments (MedPay) on Your California Auto Insurance

What medical payments (MedPay) covers and who can use it

Medical payments coverage (often called MedPay) is an optional part of many California auto insurance policies. It pays for reasonable and necessary medical, dental, funeral, and related expenses after an auto accident, regardless of who was at fault. Typical features:

• Covers the policyholder, household members, and passengers injured in the covered vehicle.
• May also cover you if you are hit as a pedestrian or injured while in another vehicle, depending on your policy language.
• Has dollar limits (for example, $1,000, $5,000, $10,000). Check your declarations page for your limit.

How MedPay interacts with other benefits

MedPay supplements or fills gaps. It usually pays regardless of health insurance, but policy language controls whether the insurer seeks reimbursement from health benefits or from later recoveries against the at-fault driver (subrogation). Read your policy or ask your insurer how they coordinate with:

• Health insurance and Medicare/Medicaid.
• Workers’ compensation if the injury occurred at work.
• Liability claims you pursue against an at-fault driver.

Step-by-step: How to file a MedPay claim in California

1. Get medical care immediately. Seek emergency care when needed. Keep all medical records, bills, receipts, prescriptions, and doctor notes.
2. Notify your insurer quickly. Call your auto insurer or use their online claim portal. Provide your policy number, the date and location of the accident, a short description of injuries, and the parties involved.
3. Complete claim forms and authorizations. The insurer will ask you to complete a claim form and usually a medical authorization (HIPAA release) so they can obtain records and bills. Sign and return these promptly.
4. Submit proof of loss. Provide itemized medical bills, proof of payment or outstanding balances, physician notes, diagnostic test results, and any police report or photos that support your claim.
5. Cooperate with reasonable requests. The insurer may ask for additional documents or examinations. Respond in a timely way to avoid delays or denial.
6. Track payments and denials. The insurer may pay providers directly or reimburse you. If they deny or limit payment, ask for a written explanation and the policy language they rely on.
7. Watch for subrogation. If you later recover money from the at-fault party, your insurer may assert a right to repayment of MedPay amounts paid. Keep that in mind when negotiating settlements.

Documents and evidence to gather

• Insurance card and policy declarations page.
• Police report or incident report, if available.
• All medical records, itemized bills, receipts, and current balances.
• Photos of injuries and vehicle damage.
• Names and contact information for witnesses and medical providers.
• Proof of wages lost or related expenses, if applicable.

Common issues and how to handle them

• If the insurer delays or denies, ask for a written denial with reasons and cite the relevant policy provisions.
• If the insurer asks for an independent medical exam (IME), attend if properly noticed; you can also get a written opinion from your treating provider.
• If your provider is unpaid, check whether the insurer sent payment to you or the provider and provide any missing information quickly.
• If the insurer demands repayment after you obtain a third-party recovery, review your policy and any lien notices carefully and consider legal advice.

When to talk to a lawyer

Consider consulting a California attorney if:

• The insurer denies coverage or refuses to pay reasonable medical bills.
• You face a large subrogation demand after collecting from an at-fault driver.
• Liability is contested and you need to pursue a larger liability claim for pain and suffering or future medical care.

California law and consumer resources

California governs insurance contracts under the California Insurance Code. For general consumer guidance, see the California Department of Insurance consumer pages at https://www.insurance.ca.gov/01-consumers/. For the statutory code governing insurance, start at the California Legislative Information site for the Insurance Code: https://leginfo.legislature.ca.gov/faces/codes.xhtml. Your specific policy language controls many MedPay rules, so review the policy declarations and conditions carefully.

Helpful Hints

• File the claim early. Prompt notice prevents avoidable denials or delays.
• Keep a claim file folder with every bill, form, call log, and email about the claim.
• Ask the insurer for the claim number and a direct claim adjuster contact.
• Never sign away your right to pursue a third-party claim without understanding subrogation and repayment obligations.
• Read your policy’s MedPay section to learn limits, covered persons, and subrogation language.
• If an insurer offers a settlement, get the offer in writing and understand whether it affects other claims.
• If you have health insurance, coordinate benefits but keep copies of all bills to submit to MedPay for potential reimbursement.