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Insurance Expert Witness: What Exactly Is Med Pay?

When questions and concerns about medical insurance arise, an insurance expert witness may be needed to strengthen the case.

This is especially important when certain issues arise that may affect coverage, recovery and treatment. If the case involves the possible bad-faith behavior of an insurance company that is supplying the policy for medical treatment, both a lawyer and an insurance expert witness may be necessary to resolve the matter. Other matters may concern settlements and recovery of injuries when payments must be made to complete the financial obligations of the healthcare facility and physician.

What is Med Pay?

As applied to a person, med pay insurance is a no-fault coverage policy that ensures medical bills are paid to any party that was on the premises of the insured person no matter who is responsible for the instance of injury. This stipulation of insurance that is med pay is not beneficial to the insured individual for the complications of harm but when
a visitor is on the property and has sustained some form of injury while there. Though purchased for these circumstances, the insurance only pays out for these healthcare costs when the other party has encountered some type of danger and has become hurt in the process. This may protect the insured person from litigation because the bills are covered to make the victim whole after the accident.

However, there are many exclusions that may be provided to ensure the insured person is capable of refusing payment with a med pay claim which is not determined as bad faith. These are most often observed during instances of fraudulent claims, excessive billing for various concerns and charges for medical issues that are independent of the injury on the premises. Unfortunately, when the insured party believes the payment for these costs is not warranted by the injured person does, a judge or jury panel must consider the facts, evidence and opinions to provide a judgment of who is in the right in these situations. Med pay coverage payments are usually small, and the use of a courtroom to settle these matters may cost more than resolving the matter initially.

Insurance Expert Witness

Expert witnesses often have expertise in a field that requires years of study, research or first-hand observations that provide knowledge and understanding of the subject matter. For an insurance expert witness, the policies, laws implemented, stipulations and specifics about situations may be comprehended in manners that lawyers, judges and other experts cannot. It is because of this that an insurance expert witness is sought in cases where med pay is concerned. These circumstances where bad faith is implied or sought for damages lead these professionals to detail how the insured person may exclude the injured because of fraud or pre-existing conditions.

Med pay may complicate the case because of the no-fault stipulation. That means if a fraudulent claim occurs, it may be difficult to prove the person was not actually harmed when he or she brought the case forward. An insurance expert witness is often necessary to prove how the claim is a fraud or that the injury was not part of what occurred at the premises. Additional expert witnesses may be hired to assist in extrapolating the details of what occurred through a reconstruction of the incident. However, it is the insurance professional that provides the information about how med pay policies apply and why the individual maybe excluded from medical payment allocations.

Complications of Insured Party and use of Med Pay

When the insurance party promises to pay for medical expenses to the healthcare facility of the victim when he or she is harmed while on the premises, there are some situations where the individual or entity refuses to do so afterwards. Because the stipulation in med pay is a no-fault one, the expenses are paid regardless of who is at fault in the incident. This also means that there is no reasonable proof needed to establish the medical claim for injury. Unfortunately for the injured party, if the insured entity or person refuses on the ground he, she or they are not responsible for repaying medical costs, a lawyer and insurance expert witness may become necessary.

Hiring an Insurance Expert Witness

To provide assistance and details about insurance policies and stipulations, an insurance expert witness should be hired for his or her testimony in a case. Conclusions may be drawn from his or her expertise and understanding of how the situation applies to med pay.

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Disclaimer: While every effort has been made to ensure the accuracy of this publication, it is not intended to provide legal advice as individual situations will differ and should be discussed with an expert and/or lawyer.

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