Medical Payments is a coverage that is listed in a Commercial General Liability (CGL) Insurance Policy. Most businesses typically have a CGL Policy. Medical Payments coverage pays emergency medical expenses for bodily injury to you if you had an accident on someone else’s property.
If you are an insured or are an employee of the company, it may or will not cover you and you should look into the workers compensation coverage.
Medical Payments coverage pays for your medical expenses regardless of who is at fault.
You do not have to prove that someone’s negligence (carelessness) caused your accident in order to get your medical bills paid from the Medical Payments portion of a CGL policy.
Looking for Medical Payments coverage is one of the things that you should do if you slip and fall at a store or business. Medical payments coverage will not pay for your lost wages or pain and suffering.
If you want to get your lost wages paid, read these 4 tips for getting paid for missing work after an accident. You can get money for pain and suffering in a slip, trip or fall or other injury on the premises of another if you can prove that they caused your accident.
Because some companies do not have Medical Payments coverage – or the amount is limited – you should know what to do after you receive a medical bill from your accident at a store, mall, hotel or other premises.
There are times when “Medical Payments” will not pay for your medical expenses such as:
- If you are an “insured” or for anyone hired to do work for the insured
- To anyone entitled to benefits under a workers compensation or disability benefits law
- To any athletic participants
- For anything excluded under the Bodily Injury Liability portion of the CGL insurance policy.
Companies with locations in Florida that most likely do not have Medical Payments coverage:
- Apple Stores
- Carnival Cruise Lines
- Chevron gas stations (corporate owned)
- Costco Wholesale
- CVS pharmacy stores
- Publix Supermarkets
- Royal Caribbean Cruises
- Sedanos Supermarket
- See’s Candies Chocolate Shops
- Target Stores
- Texaco gas stations (corporate owned)
- Walmart Stores
- Walt Disney World
- Winn Dixie
You should note that the insurance policies for the above companies may changed since the last time that I dealt with the above companies. I have seen the following type of companies, all which were franchisees or small privately owned non-franchised businesses, provide Medical Payments coverage:
- Chevron gas stations (franchisee owned)
- Denny’s restaurant
- Exxon and Mobil gas stations (All stations are franchisees)
- Hyatt hotel
- Property Owners who lease space to a restaurant
- Day Spas, salons and barber shops
- Taverna Opa restaurant
- Texaco gas stations (franchisee owned)
- W hotel in Fort Lauderdale, Florida
Generally small businesses are more likely to have Medical Payments coverage than large “big box” stores. Let me give an example of how Medical Payments coverage may apply.
Assume you are injured when you fall from a booth that was loose at a restaurant. You fracture your wrist and go to the hospital.
An ambulance arrived at the scene but you decided that you did not want to be transported. Later that night you went to the hospital because the pain in your wrist is bad.
You receive hospital bills that are over $1,200. The restaurant is aware of your incident because the paramedics came into the restaurant to examine you.
Assume Denny’s is insured with Travelers Insurance Company and has a $1,000 medical expense limit under its Medical Payments coverage portion of its CGL insurance policy.
If you set up a claim with Travelers Insurance Company and send them the hospital bill, they will pay the hospital up to $1,000. This is true even if Travelers does not believe that you will be able to prove that the restaurant’s negligence caused your injuries.
If you have already paid the hospital bill, Travelers Insurance Company will reimburse (pay) you $1,000.
If your health insurance has already paid the hospital bill, and you settle your personal injury case against the restaurant, you may be legally required to pay the health insurance company back for bills that they paid which were related to the accident.
If you had health insurance, you may be able to use the medical payments coverage to pay your health insurance company’s lien if they have a lien, but you should wait to the end of your personal injury case before paying this lien off.
Time limit to send medical records and bills to the Liability Insurer for the Business
There is a deadline for you to submit your medical records and bills to the liability insurer for the business (restaurant, store, etc.).
If you wait too long to send the liability insurer your bills, they may not pay your bills. I have seen the time to send your medical records and bills to the liability to be as short as 1 year.
Time limit may be extended
In Florida, the time limit to make a Medpay claim with the CGL insurer may be extended. This may occur if you send a written request, pursuant to Florida Statute 627.4137, for insurance disclosure information from the insured or the CGL insurer and they fail to produce a certified copy of the policy.
Example – Coverage defense rejected for failure to provide copy of the insurance policy
Below is an example of when a Florida you may get an extension to the time limitation to submit bills/records to the Medpay insurer. Although the example deals with uninsured motorist (UM) benefits and not Medpay, the reasoning is the same.
Jeanne Rousseau was injured while riding as a passenger in a motor vehicle involved in an automobile accident. Her Gainesville attorney filed a lawsuit for uninsured motorist (UM) benefits against United Automobile Insurance Company (UAIC), who was the insurer for the owner of the motor vehicle in which she was a passenger.
UAIC argued that she was not entitled to UM benefits because she failed to prove compliance with conditions precedent in the UAIC insurance policy. She, as an omnibus insured, did not have a copy of the UAIC insurance policy.
She through her attorney, repeatedly requested a copy of the policy and that UAIC failed to provide a copy of the policy. The insurer failed to comply with subsection 627.4137(1)(e), Florida Statutes, which requires that an insurer “shall provide” a copy of the policy “within 30 days of the written request of the claimant.” Cf. Allstate Ins. Co. v. Singletary, 540 So.2d 938 (Fla. 2d DCA 1989).
The trial court refused to dismiss the case for the passenger’s failure to comply with conditions precedent. The passenger was awarded attorney’s fees pursuant to Florida Statute 627.428 because the insurer’s sole argument relates to a coverage issue.
The coverage issue is that the insurer’s sole argument that the passenger was not entitled to UM coverage as a result of her alleged failure to comply with conditions precedent in the insurance policy. See State Farm Mut. Auto. Ins. Co. v. Lynch, 661 So.2d 1227, 1230 (Fla. 3d DCA 1995).
Tip: Attorneys normally should not charge an attorney’s fee on recovering Medpay benefits. However, if the attorney has to sue to get Medpay, he is allowed to charge attorney’s fees.
Example #2 – Coverage defense rejected for failure to give copy of policy
In the case of Figueroa v. U.S. Sec. Ins. Co., 664 So.2d 1130 (Fla. 3d DCA 1995), the trial court granted judgment based on insurer’s, U.S. Security Insurance Company, defense that insureds failed to provide timely a sworn statement.
U.S. Security is now known as Mendota Insurance. This is a Miami-Dade County case.
The appeals court said that although the failure to submit a sworn statement constitutes a material breach of the policy, Stringer v. Fireman’s Fund Ins. Co.,622 So.2d 145 (Fla. 3d DCA), review denied, 630 So.2d 1101 (Fla. 1993), under the facts and circumstances of this case.
They reversed the summary judgment.
Here, the insurer, who admitted coverage, failed to comply with insureds’ requests for a copy of the policy, and insureds agreed to give sworn statements after receiving a copy of the policy which set forth the obligation to give a sworn statement. See Crown Life Ins. Co. v. McBride, 517 So.2d 660, 661 (Fla. 1987);Allstate Ins. Co. v. Singletary, 540 So.2d 938 (Fla. 2d DCA 1989); § 627.4137, Fla. Stat. (1993). Cf. Goldman v. State Farm Fire Gen. Ins. Co., 660 So.2d 300, 305 (Fla. 4th DCA 1995) (compliance two years after loss “satisfies neither the spirit nor intent of the policy conditions at issue.”).
The insurer lost its coverage defense for failing to give the insured a copy of the policy.
Tip: The claimant should agree in writing to comply with any legal requirements in the policy after receiving a copy of the sworn policy which sets for the obligation. The injured person will look good in front of the judge for offering to be reasonable.
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Editor’s Note: This post was originally published in 2013 and has been completely revamped and updated.