Using Your Own Insurance: MedPay, UM/UIM, and Health Insurance

After a crash, most people assume the other driver's insurance company will take care of everything. It will not. That insurer owes you nothing until you prove the claim, and it has every incentive to delay. In the meantime, the bills arrive.

The good news is that you probably already own coverage that can help right now. This chapter walks through those policies, what each one does, and the traps in the fine print. The coverage you bought for yourself is a contract, and you are entitled to use it without apology.

Start with your declarations page

Your declarations page (the "dec page") is the short summary at the front of your auto policy listing every coverage you bought and its dollar limit. Pull it out, or log in to your insurer's app, and look for these lines:

• Bodily injury liability. This pays other people you injure. It does not pay you.
• Medical payments (MedPay). Pays medical bills for you and your passengers after a crash regardless of fault. Common limits are $1,000 to $10,000.
• Uninsured motorist (UM) and underinsured motorist (UIM). Pays you when the at-fault driver has no insurance or not enough. This is the most valuable line on the page for a serious injury.
• Collision. Repairs or replaces your vehicle regardless of fault, minus your deductible.
• Rental reimbursement. Pays for a rental car while yours is being repaired.

If a line says "rejected" or shows no limit, you do not have that coverage. If you cannot tell, ask your agent for the full policy.

Why you should use your health insurance first

Many clients hesitate to run crash-related treatment through health insurance, because the other driver "should" pay. Use it anyway.

Hospitals and doctors have contracts with health insurers that require them to accept a reduced rate as payment in full. A $12,000 emergency room bill might be satisfied by a $3,500 contractual payment, and that write-off is money that no longer has to come out of your settlement.

Your health insurer will likely have a right to be repaid from your recovery, called subrogation, but under R.C. 2323.44 its claim is reduced in proportion to yours when limited insurance or shared fault keeps you from being fully compensated. We explain this in Medical Bills, Health Insurance, and Liens. A lien based on the discounted paid amount is far smaller than one based on full billed charges.

MedPay: the coverage you already paid for

MedPay pays medical expenses for you and your passengers no matter who caused the crash. There is no deductible and no fault determination. You submit the bills, and the insurer pays up to the limit.

MedPay is most useful for covering deductibles and copays your health insurance leaves behind, paying for treatment when you have no health insurance, and keeping providers from sending you to collections while the liability claim drags on.

Some MedPay policies include a reimbursement clause, meaning the insurer may ask to be repaid from your settlement; whether that applies depends on the policy language and on R.C. 2323.44. We cover how MedPay carriers sometimes mishandle these claims in our post on MedPay and insurance bad faith in Ohio.

UM/UIM coverage: your protection against the underinsured driver

Ohio requires drivers to carry only $25,000 per person in bodily injury liability coverage. A surgery or a week in the hospital will exceed that in days, and many at-fault drivers carry the minimum or nothing at all.

That is what UM/UIM coverage is for. Under R.C. 3937.18, Ohio insurers may offer it but are not required to, so check your dec page. We devote an entire practice page to UM/UIM claims in Ohio; the points below are the ones that surprise people most.

Uninsured motorist (UM)

UM coverage applies when the at-fault driver has no liability insurance, when the driver's insurer denies coverage or is insolvent, and in hit-and-run cases where the driver cannot be identified. R.C. 3937.18 requires some corroborating evidence for an unidentified-driver claim, so photographs, witness names, and a prompt police report matter. See our page on hit-and-run and uninsured driver claims.

Underinsured motorist (UIM) and the setoff

UIM coverage applies when the at-fault driver has insurance, but less than your UIM limit. R.C. 3937.18(C) provides that your UIM limit is reduced by the amount available from the at-fault driver's liability coverage; UIM fills the gap between that policy and your own limit rather than stacking on top of it.

An example:

• Your injuries are worth $150,000.
• The at-fault driver has $25,000 in liability coverage.
• You carry $100,000 in UIM coverage.

You collect $25,000 from the at-fault driver's insurer. Your UIM carrier then owes at most $75,000 ($100,000 minus the $25,000 available from the liability policy), for a total recovery of $100,000, not $150,000. If you carried only $25,000 in UIM coverage, you would recover nothing from UIM, because your limit does not exceed the at-fault driver's. That is why we tell every client and every friend to buy as much UM/UIM as they can afford; it is the one coverage that protects you from someone else's bad decisions.

Consent-to-settle clauses

Nearly every auto policy says you may not settle with the at-fault driver without your insurer's written consent. The reason is subrogation: once your UIM carrier pays you, R.C. 3937.18(J) gives it the right to pursue the at-fault driver for what it paid. If you sign a release with the at-fault driver first, you may destroy that right, and the carrier may use it to deny your UIM claim.

The proper sequence is to notify your UIM carrier of the liability insurer's offer and request consent. The carrier can consent, or pay you the same amount itself and keep its claim against the at-fault driver. Do not sign any release until this step is done; it is one of the most common mistakes we see, and we discuss it in Social Media and Other Mistakes That Hurt Your Case.

Notice requirements and the contractual deadline

Your policy requires prompt notice of a crash and of any potential UM/UIM claim. A short email to your agent saying you were hit by another driver and may have a UM/UIM claim protects you and obligates you to nothing.

Separately, R.C. 3937.18(H) allows the policy to require that a UM/UIM claim be made or suit filed within three years of the crash (or within one year after the at-fault driver's insurer becomes insolvent, whichever is later). Three years sounds generous, but UIM claims often do not ripen until treatment is finished and the at-fault driver's limits are known. Do not let a slow liability claim run out the clock on your own coverage.

Who is covered

UM/UIM coverage typically extends to the named insured, a spouse, and relatives who live in the household, whether they are in the insured car, another car, or on foot. A child injured as a passenger in a friend's car may have UIM coverage under a parent's policy. R.C. 3937.18(I) does allow insurers to exclude injuries in a vehicle the family owns or regularly uses but did not list on the policy, so tell your agent about every car and motorcycle in the household before you need the coverage.

R.C. 3937.18(F) also lets policies prohibit "stacking," which is combining UM/UIM limits from multiple vehicles or policies, and most do. Even so, more than one policy sometimes applies (yours and the policy on the car you were riding in, for instance), and sorting out which coverages are available is part of what we do.

Will my rates go up?

Ohio law addresses this directly for private passenger auto policies. R.C. 3937.22 prohibits an insurer from raising the cost of your policy based on a single crash during the policy period when your conduct was not a proximate cause of the loss and you were not convicted of a traffic violation from the crash, and R.C. 3937.23 applies the same rule to a crash with an uninsured or underinsured driver. Those statutes cover premium increases, not every underwriting decision, and they have conditions, so if an adjuster suggests that using your UM/UIM coverage will "count against you," ask your agent to put the company's position in writing. The fear of a rate increase is far more common than the increase itself.

Collision coverage and subrogation

If the at-fault driver's insurer has not accepted liability, your collision coverage is usually the fastest way to get your car fixed. You pay your deductible, your insurer pays the shop, and your insurer then pursues the at-fault driver's insurer for reimbursement (subrogation) and returns your deductible when it recovers. Using collision coverage does not weaken your injury claim, and it keeps the property damage from becoming leverage the adjuster can use against you; we discuss that tactic in Dealing With Insurance Adjusters.

Rental coverage

If you bought rental reimbursement, use it; the at-fault driver's insurer should ultimately pay for a rental while your car is repaired or replaced, but that reimbursement often takes weeks. Keep every receipt.

Suing your own insurer

A UM/UIM claim is a contract claim, so if your insurer refuses to pay what the coverage is worth, the remedy is a lawsuit against your own company, subject to the three-year policy deadline described above. Your insurer must also handle your claim in good faith; one that denies or delays without a reasonable justification exposes itself to additional liability. That is a reason to get a lawyer involved before the first lowball offer.

Key takeaways

• Read your declarations page now, before you need it. Confirm you have MedPay, collision, and especially UM/UIM.
• Use your health insurance for treatment. Contractual rates shrink the bills and the liens.
• UIM pays only the amount by which your limit exceeds the at-fault driver's limit. Buy more than the minimum.
• Never sign a release with the at-fault driver before your UIM carrier consents in writing.
• Give your own insurer prompt notice and watch the contractual deadline, which may be as short as three years.
• Ohio law bars premium increases for most not-at-fault crashes; ask your agent to confirm in writing.