Med Pay or Health Insurance

January 3, 2011

Recently, many health insurance carriers are requesting we reimburse them under the Med Pay portion of the Homeowner policy (HO 00 03 4/91 Section 11 coverage F). Could you explain Section 11 – Exclusion 3. Cov F Med Pay to others part b (1). To any person eligible to receive benefits; “voluntarily provided”; could this mean health insurance?

Section 11 conditions, part 8 “Other insurance” appears to apply only to Coverage E and not Coverage F (Med Pay)
Your thoughts regarding who is primary?

Massachusetts Subscriber

Med pay coverage applies when an accident occurs that results in injury to another party resulting from a condition at the insured premises or caused by activities of the insured; for example the porch steps break and a neighbor is coming up the steps, or the dog bites the neighbor coming over for dinner. Exclusion 3 b.1. refers to people covered under workers compensation, non-occupational disability law, or occupational disease law. Section b. needs to be read entirely – benefits are excluded if the benefits are voluntary or required to be provided under any: (emphasis added) workers comp, non-occupational disability, etc.

 

Indeed part 8 states that coverage E is excess over other valid and collectible insurance except when other coverage is specifically written as excess over the home policy.

 

If a neighbor gets injured on an insured's property and in the ER gives his health information because he doesn't have his neighbor's insurance policy, the health insurance carrier is correct in subrogating against the homeowner's carrier. The loss should be paid under med pay on the homeowners form, that is what it is there for.

 

This premium content is locked for FC&S Coverage Interpretation Subscribers

Enjoy unlimited access to the trusted solution for successful interpretation and analyses of complex insurance policies.

  • Quality content from industry experts with over 60 years insurance experience, combined
  • Customizable alerts of changes in relevant policies and trends
  • Search and navigate Q&As to find answers to your specific questions
  • Filter by article, discussion, analysis and more to find the exact information you’re looking for
  • Continually updated to bring you the latest reports, trending topics, and coverage analysis