Medical Payments Coverage Versus Liability Coverage

MEDICAL PAYMENTS COVERAGE versus LIABILITY COVERAGE

This recent case, Barnes vs. Western Heritage, discusses these two types of coverages. In this case, an 11 year old boy was injured at an after school activity sponsored by “Shingletown”. Shingletown had liability coverage, and medical payments coverage thru their insurance company, Western Heritage. Medical payments coverage provides for the payment of medical bills when someone is injured on the premises. It does not matter if the person, and/or property owner is negligent. The insurance company paid some of the boy’s medical bills. He then sued Shingletown for negligence. During the litigation, a demand was made for the insurance company to pay some new medical bills that were incurred. The insurance company denied this claim, saying that it was made too late.

The lawsuit against Shingletown proceeded, and settled. The boy then filed a lawsuit against the insurance company, claiming they were wrong in not paying the additional medical bills, when the insurance company said they were too late. The insurance company claimed that since the lawsuit filed against Shingletown had settled, the boy was not entitled to recover anything under the medical payments coverage provision. The appellate court agreed with the boy, and said these two claims were different, and the first lawsuit was against Shingletown, and not the insurance company. The lawsuit against the insurance company was for breach of contract, wherein the boy claimed that the insurance company had breached its contract by not paying the claim under the medical payments provision.