Detailed Answer
This article explains, in plain language, how to make a claim under the medical payments portion of an auto insurance policy in Maryland (often called “MedPay”). It covers what MedPay is, who it covers, what paperwork you will need, how to report and pursue a claim, coordination with other insurance, common reasons claims are denied, and when you may want to speak to an attorney or file a complaint with the Maryland Insurance Administration. This is educational information only and is not legal advice.
What is medical payments (MedPay) coverage?
MedPay is an optional portion of many auto insurance policies that pays for reasonable medical expenses for you and, depending on the policy language, passengers injured in an auto crash — regardless of who caused the accident. MedPay typically covers things like emergency room bills, ambulance fees, doctor visits, X-rays, and sometimes rehabilitation costs, up to the policy limit. It is separate from liability coverage and from bodily-injury claims you might bring against a driver who caused the crash.
Who is covered under MedPay?
Coverage depends on the contract language. Many policies cover: the named insured, family members living with the insured, and any passengers occupying the insured vehicle. Some policies also extend MedPay to the insured while riding in someone else’s vehicle. Check your declarations page and the policy definitions to see exactly who is covered.
Step-by-step: How to file a MedPay claim in Maryland
- Get medical care right away. Prompt treatment helps your health and creates medical records that document injury and treatment. Keep all records, bills, receipts, and doctor notes.
- Locate your insurance policy and declarations page. Identify the MedPay limit (for example, $1,000, $5,000), the insurer’s claims contact information, and any special claim procedures in the policy. The declarations page is usually the first page of the policy packet.
- Report the claim to your auto insurer immediately. Use the insurer’s claims phone number or online portal. Give basic facts: date/time/location of the accident, who was injured, how they were injured, and whether police or ambulances attended. Ask for a claim number and the name/contact for the adjuster handling the file.
- Collect and submit documents. Insurers usually require a claim form plus supporting documents. Typical documents to submit:
- Copies of all medical bills and itemized statements.
- Medical records or provider notes showing treatment for injuries from the crash.
- Proof of payment or outstanding balances.
- Police crash report (if any) or an accident statement.
- Photos of the crash and injuries, if available.
- Answer follow-up questions quickly. The company may request additional medical records or a signed authorization to obtain records. Provide this promptly so the adjuster can evaluate the claim.
- Ask whether MedPay is primary or secondary. Some MedPay policies pay first (primary) regardless of your health insurance; others pay only after your health insurer pays (secondary). That affects where you submit bills first and which insurer you notify.
- Understand subrogation and reimbursement. If MedPay pays your bills and you later recover money from the at-fault driver (for example, by settlement or judgment), your insurer may have a right to be reimbursed from that recovery. That right is called subrogation. Keep copies of any recoveries and coordinate with both insurers and any lawyers involved.
- If the insurer denies or delays payment, ask for a written explanation. If unsatisfied, follow the insurer’s internal appeal process and consider filing a complaint with the Maryland Insurance Administration (see “Resources” below).
What to expect on timing and amounts
MedPay pays only up to the policy’s stated limit and only for covered expenses that are reasonable and related to the crash. Processing time varies by insurer and can depend on how quickly you provide medical records and bills. Ask your adjuster for an expected timeline. Keep a log of all calls and correspondence (date, time, person spoken to, and summary).
Common reasons MedPay claims are reduced or denied
- Treatment is unrelated to the reported crash.
- Insufficient documentation: missing medical records, unsigned bills, or missing provider notes.
- Expenses exceed policy limits or insurer finds charges are not reasonable for the local area.
- Late notice of claim or failure to cooperate with the investigation (check your policy for required timelines).
- Fraud or misrepresentation (e.g., false statements about how injuries occurred).
When to consider an attorney or filing a complaint
Consider contacting an attorney if one or more of the following applies:
- You have serious or permanent injuries and need help coordinating recovery from different insurers.
- The insurer unreasonably delays, underpays, or denies a claim and you cannot resolve it through appeals.
- You believe the insurer acted in bad faith (for example, denied coverage without a reasonable basis).
If you cannot resolve the problem with your insurer, you may file a complaint with the Maryland Insurance Administration (MIA). The MIA handles consumer complaints about auto insurance practices and can explain your rights and options. See the Resources section below for links.
Coordination with other claims (liability claims and health insurance)
MedPay is not the same as a bodily-injury lawsuit against a negligent driver. MedPay can provide immediate payment for medical bills regardless of fault. If you later pursue a liability claim against an at-fault driver and recover money, remember your insurer may assert subrogation rights to be repaid for amounts MedPay paid. If you have health insurance, ask how MedPay interacts with it: some MedPay is primary, some secondary.
Practical checklist before submitting a claim
- Copy of your policy declarations page showing MedPay limits.
- List of medical providers, dates of treatment, and itemized bills.
- Police report number (if any) and accident photos.
- Claim report to insurer (date, name of person spoken to, claim number).
- Signed medical release form if insurer requests it.
Resources
Maryland Insurance Administration (consumer information, complaints, and guidance): https://insurance.maryland.gov/
Maryland State Bar Association (to find attorneys in Maryland): https://www.msba.org/
Important: Insurance policies are contracts. Exact rights and duties depend on your specific policy language and the facts of your accident. The Maryland Insurance Administration can help with complaints about claims handling, and if you have questions about suing for additional damages you may wish to consult a licensed Maryland attorney.
This is not legal advice. If you need legal advice about ownership, coverage disputes, subrogation, or litigation, consult a licensed attorney in Maryland.
Helpful Hints
- File the claim immediately after the accident — prompt reporting makes processing easier.
- Keep originals and make copies of all medical bills and receipts.
- Ask your adjuster whether MedPay will be primary or secondary and follow their directions for submitting bills.
- Request written explanations for any denials or partial payments; these help with appeals and complaints.
- Keep a short log of calls with the insurance company (date, time, rep name, summary).
- If you settle a liability claim, get the settlement terms in writing and be aware of any subrogation lien the insurer may assert.
- If you’re unsure whether a charge is related to the crash, ask your treating provider to document the link in their notes.
- Before signing any release from an at-fault driver’s insurer, speak with a lawyer if you still have unpaid medical bills or unresolved claims — releases can affect subrogation and future recovery.