When Does an Insurer Become Obligated to Make Medical Payments?
In Alabama, an insurance company becomes obligated to make medical payments when its insured suffers a bodily injury and incurs medical bills resulting from treatment of the injury.
As with any general conversation about insurance coverage, there is a giant caveat that must be stated – the outcome of any coverage question depends on the specific language of a particular policy.
With that being said, typically in Alabama, medical payments (“med-pay”) coverage is written into auto policies. Unlike other types of coverage, med-pay is “no-fault” coverage. The med-pay provision of a personal auto insurance policy does not require that an insured be legally entitled to recover in order for medical payments to be made. Med-pay coverage typically simply requires that in order for medical payments to be made, the insured must have incurred necessary medical expenses subsequent to a bodily injury caused by an accident.
An insurer may decline to make medical payments if it determines either that the insured did not sustain a bodily injury caused by an accident, or that the insured, subsequent to an accident, did not incur medical bills within the timeframe identified in the policy. However, in order to maintain this position, the insurer must through the course of a claim (or subsequent litigation) continue to assert its denial and cannot admit that the insured has suffered a bodily injury as defined in the policy.