California Medical Pay Insurance Coverage

In the case of an automobile accident causing injuries, the child may, depending on whether his or her parents elected to have the benefits on their auto policy, have access to “no-fault” medical benefits under a California Medical Pay Policy (first-party insurance coverage) issued to one of the parents (assuming the injured child is a passenger in the vehicle). The term “no-fault” means that the coverage is available, regardless of whether or not the claimant was at fault for ICD-9 is an acronym used in the medical field. It stands for International Classification of Diseases, ninth revision. In the United States, the ICD-9 covered the years 1979 to 1998. Currently, ICD-10, which is the tenth revision, is in effect as the most current database of disease classifications. ICD-9 was used in the United States until the 10th revision became fully implemented in 1998, though the actual revision was concluded some years earlier.

The accident, and all medical pay benefits in California are no fault. In California, having medical pay benefits is not required, and you must elect to have it on your auto policy. I have always highly recommended that everyone in California who drives an automobile obtain these benefits on their auto policy. In the case of a child pedestrian accident (when a child has been hit and injured by a motor vehicle), most people are unaware that the injured child may also have access to his or her own medical pay coverage underneath his or her families’ automobile liability policy. If the family auto policy has it, and it applies under the specific facts of how your child was injured, then this is another source of insurance coverage. In the case of a premises liability insurance policy, such as a homeowner’s policy or business premises insurance policy, a child may have access to no-fault medical payment benefits too. These policies will usually provide coverage if the child who was injured on the premises, and there is an insurance policy in place. This coverage is also no fault. Remember, though, that when an insurance company pays, it does not mean it is necessarily admitting fault for the premises injury.

For instance, if a child slips and falls in a person’s home, that injured child should have access to no-fault medical benefits under the homeowner’s insurance policy—regardless of whether or not the homeowner was at fault. The same is usually true if the injury occurred in a commercial business, theme park, or mall that carries this type of insurance coverage. These no-fault medical benefits are often limited and coverage may not, oftentimes, exceed $5,000 to $10,000. In my injury practice, in regards to premise liability cases, I have seen no-fault medical pay coverage range from as low as $1,000 to as high as $25,000.

Legal Research for above Article Posting:  Gunnar BJ Andersson, Linda Cocchiarella, Guides to the Evaluation of Permanent Impairment, Fifth Edition, American Medical Association.


Mark Blane
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San Diego Personal Injury Lawyer | California Car Accident Attorney