Auto Insurance: Frequently asked questions

Our personal auto insured was recently involved in an at-fault accident. She has $10,000 of medical payments coverage on her policy. The insurer paid about $4,400 for her hospital treatment.

Since the accident, she has been having nightmares. She has been unable to sleep or perform her job effectively. She has lost a great amount of weight.

Recently she began seeing a psychologist, who diagnosed her problem as "post-traumatic stress disorder" (PTSD) resulting from the accident. We have turned in the psychologist's bills to the auto insurer and they have denied payment saying that PTSD is not covered by medical payments.

Since her condition is directly related to the accident, we believe that these bills should be covered by the PAP.

What do you think?

The insuring agreement in the medical payments section of the personal auto policy (PAP) promises to pay "reasonable expenses incurred for necessary medical and funeral services because of 'bodily injury.'" The bodily injury must be sustained by an insured and caused by an accident.

The policy defines "bodily injury" as "bodily harm, sickness or disease, including death that results." Post-traumatic stress disorder is a psychological injury. It certainly may have physical manifestations, but it is a psychological injury.

Some states have defined bodily injury to include psychological injury. If Illinois has done so, then your client may be able to collect under her medical payments coverage. As it stands now, we believe the insurer is correct to deny the claim.

In reviewing the amendatory endorsements, it appears that only two states, Colorado and Kansas, specify psychological injuries as covered under medical payments—and those are no-fault states that include such coverage within personal injury protection (PIP).

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