Louisiana automobile insurance companies have 30 days after receiving satisfactory proof of loss to make unconditional tenders in UM claims. See La. R.S. 22:1892. This same timeline governs Medical Payments or Med Pay claims. Med Pay is coverage for medical bills arising out of an auto accident. Generally, this coverage, when purchased, covers the insured’s medical bills in automobile accidents regardless of which driver was at fault. Med Pay cannot be utilized to pay pain and suffering arising out of personal injury, but can be used to pay bills for accident related medical treatment.
Med Pay coverage usually covers each occupant of an automobile for all accident related medical bills up to $1,000.00 or $5,000.00. But a person seeking to utilize Med Pay coverage, should always check the insurance policy that allegedly provides Med Pay coverage. Certain exclusions may apply. For example, Med Pay is often excluded in accidents otherwise covered by workers’ compensation coverage. Thus, you often cannot use Med Pay when you can utilize workers’ compensation benefits for accident you are involved in while in the course and scope of your employment.
After you sustain an injury and incur medical bills, you or your attorney should send those medical bills to the insurance company that issued the Med Pay coverage. This will constitute satisfactory proof of loss in most cases. Satisfactory Proof of Loss is that which suffices to fully apprise the insurer of the insured’s claim. McDill v. Utica Mut. Ins. Co., 475 So. 1085, 1089 (La. 1985).
After receiving medical records and bills after an accident the insurance company has 30 days to tender medical payments up to the amount of Med Pay coverage provided in the policy. An auto insurer’s unexcused and unexplained failure to pay a Med Pay claim within 30 days of its receipt of satisfactory proof of loss will likely be deemed without probably cause and subject the insurer to penalties and attorney fees. See Higgins v. USAA, 669 So. 2d 498 (La. App. 4 Cir. 1996).
If you or a loved one has questions about insurance coverage after an accident or Med Pay claims, please contact Metairie accident attorney, Donald D’Aunoy Jr., today for a FREE consultation: 504-508-6414.