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Coverage Issues Stemming from Med Pay Claims Under Commercial Premises Liability Policies

By Chet A. Kronenberg
November 30, 2011

Medical payments (“med pay”) coverage is a part of many commercial premises liability policies. Typically, med pay covers reasonable medical expenses, regardless of fault, up to a specified limit (usually between $1,000 and $10,000) if someone is hurt on the policyholder's premises.

Med pay coverage is usually purchased for good will purposes. It is hoped that if an injured person's medical expenses are paid, it will deter the injured person from instituting a lawsuit. To illustrate: Suppose a customer slips and falls while shopping at a store and incurs medical expenses. Because med pay coverage is applicable regardless of fault, the store can arrange for its customer's medical expenses to be paid under the med pay provisions in the store's liability policy. This way, through its show of good will, the store can avoid an acrimonious exchange with the customer ' or a lawsuit ' concerning whether the slip and fall was the store's fault.

Med pay coverage has been described by some courts as “a form of minimal group accident insurance.” In many states, med pay provisions are considered third party beneficiary contracts giving the injured party a right to a direct action against the insured. Accordingly, if an insurer were to refuse to pay a med pay claim arising from an injury on the policyholder's premises, the injured party could sue the insurer directly.

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