If you remember Colorado as a no-fault state, or you moved here from one, you may expect your own auto policy’s personal injury protection, known as PIP, to pay your medical bills after a crash. Colorado has not worked that way for more than 20 years. What most Colorado policies carry instead is medical payments coverage, usually called MedPay: $5,000 that pays early medical bills no matter who caused the crash. Here is what state law and the Colorado Division of Insurance say about it, and how to use it.
Colorado dropped mandatory PIP in 2003
Colorado’s No-Fault Act, the law that required PIP, was repealed on July 1, 2003, as the U.S. Court of Appeals for the 10th Circuit noted in a 2007 decision. Since then the state has run on fault. The Division of Insurance describes the liability coverage every driver must carry as paying for injuries and property damage to other people from a crash in which you are found to be at fault. The required minimums are $25,000 per person for bodily injury, $50,000 per accident and $15,000 for property damage.
Liability coverage pays other people. It does not pay your own medical bills, and that is the gap MedPay fills. The disclosure form insurers must give Colorado buyers says a driver hurt in a crash that was his or her own fault will not get medical benefits from the auto policy unless MedPay was purchased. For the reporting rules and filing deadlines that also apply, see our guide to what you are required to do after a car crash in Colorado.
Why you probably have MedPay already
Lawmakers wrote medical payments coverage into the auto insurance code with Senate Bill 08-011, a trauma care funding law that took effect Jan. 1, 2009. As the statute reads today, an auto liability policy cannot be issued in Colorado without $5,000 of MedPay unless the named insured rejects it in writing or in the same medium used to apply for the policy. The Division of Insurance puts it plainly: $5,000 of medical payments coverage is included in your policy unless you reject it.
The statute adds a backstop. If an insurer fails to offer MedPay, or cannot produce proof that you rejected it, your policy is presumed to include the $5,000. MedPay does not have to be offered on motorcycles, low-power scooters or off-road vehicles, and drivers can buy limits higher than $5,000.
Who it covers and what it pays
- Who: you and your passengers, according to the Division of Insurance. The statute defines an injured person as the insured or a passenger the insured allowed in the vehicle.
- Fault: it pays regardless of who caused the crash.
- What: reasonable health care expenses for injuries from the crash. The statute describes medically necessary, accident-related health care and rehabilitation services from a licensed health care provider, a term the insurance code defines to include hospitals and people licensed to practice medicine, chiropractic, nursing, physical therapy, dentistry and acupuncture, among others.
- Order: MedPay pays before your health insurance, and it can be applied to your health plan’s deductible or coinsurance.
- No clawback from the other driver: an insurer that pays MedPay benefits has no right to recover that money from the driver who caused the crash.
The state’s descriptions of MedPay cover health care expenses. They do not mention lost wages or car repairs.
The 30-day trauma reserve
One detail surprises people. When your insurer gets notice of a crash, the statute requires it to reserve $5,000 of your MedPay for trauma care: ambulances and air ambulances first, then trauma physicians, then trauma centers. The reserve can be held for no more than 30 days after the accident notice. After that, whatever those providers have not claimed can be used to pay other providers’ bills. If you carry only the $5,000 minimum, a clinic bill sent in the first month may wait until that window closes.
How to use it after a crash
- Look for medical payments coverage and its dollar limit on your policy’s declarations page, or ask your agent or insurer whether you have it.
- Report the crash to your own insurer and ask how to open a MedPay claim, even if the other driver was at fault.
- Give each provider your auto claim information. State law requires a provider who examines or treats someone entitled to MedPay to notify the insurer within 30 calendar days of the first visit. Hospitals are exempt from that rule.
- Know the clock on the insurer. A clean claim must be paid, denied or settled within 30 calendar days if it was sent electronically and within 45 days otherwise. Absent fraud, other claims must be resolved within 90 days.
- Read your policy for its own time limits. The statutes checked for this article do not set a deadline for how long after a crash you can keep using MedPay, so that comes from the policy itself.
- If a claim stalls, the Division of Insurance takes consumer questions at 303-894-7490, or 800-930-3745 outside the Denver metro area, Monday through Friday from 8 a.m. to 5 p.m. Complaints are filed through its File a Complaint page.
Getting checked out, and where PIP still shows up
Because MedPay pays for accident-related care, the record of your injuries matters. One local example of what an evaluation involves: Lakeside Spine and Injury Center in Wheat Ridge, the practice of Dr. Andrew Allen, DC, describes its process for car accident injury evaluations in Wheat Ridge. The clinic says it reconstructs how the crash happened, screens for urgent problems such as head injury or fracture before any treatment, tests movement, strength and reflexes, and keeps a record that ties symptoms and exam findings to treatment and progress. It also notes that symptoms often show up later rather than at the scene.
PIP has not vanished entirely. The clinic’s page on how PIP benefits work for chiropractic care points out that people still run into PIP through out-of-state and older policies. If your auto policy was written in another state, ask that insurer what it covers. For a policy written in Colorado, the benefit to ask about is MedPay.
Disclosure: Lakeside Spine and Injury Center is a Holland Health Marketing client. Our profile of the practice is in the Local Business Spotlight.
When the bills pass $5,000
MedPay is a first layer, not the whole answer. Past your limit, the bills fall to your health insurance, to the at-fault driver’s liability coverage, or to your own uninsured and underinsured motorist coverage if that driver has no insurance or too little. The Division of Insurance says that coverage is optional in Colorado but is included in your policy unless you reject it in writing, so check your declarations page for it too.
Sources
- Colorado Division of Insurance: Auto Insurance and File a Complaint.
- Colorado Revised Statutes: section 10-4-635 (medical payments coverage), section 10-4-636 (disclosure requirements), section 10-4-642 (prompt payment) and section 10-4-601 (definitions).
- Colorado General Assembly: Senate Bill 08-011, Session Laws 2008, chapter 441.
- U.S. Court of Appeals for the 10th Circuit: Stickley v. State Farm Mutual Automobile Insurance Co. (Oct. 10, 2007).
This is general information, not legal advice.
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