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QuestionInsurance Question  If you have combined first party insurance with an overall limit of $100,000 total including $2500 funeral benefit and $10,000 accidental death benefit, does the medical benefit end at $87,500? Also does the entire medical benefit have to be used up in a three year period following the accident for extra ordinary medical benefits to go into effect? This is in PA.

AnswerAuto Insurance Answer

First Party Benefits, or FPB, has a requirement of only $5000 on Medical. The rest of the coverage options are optional auto insurance coverage in Pennsylvania. In addition, you can add First Party - Extraordinary Medical usually up to $1,000,000 for extraordinary medical coverage. Depending on the specific FPB coverages you select, if you are injured in an accident, FPB covers you and relatives residing in your same household for medical expenses, lost income, accidental death, and/or funeral costs. The amounts covered are capped at limits you select when you buy your auto insurance policy. Your medical would be capped at the amount you purchased.

First Party - Combination Package Benefits (CPB) is another optional coverage available in Pennsylvania. This package represents an alternative to buying each individual First Party coverage separately (First Party - Income Loss, First Party - Accidental Death, First Party – Funeral, First Party - Medical). CFPB auto insurance coverage provides the named insured and relatives living in the same household a combination of benefits subject to a higher aggregate limit. Depending on the company, the limits may be $50,000, $100,000, $177,500, $277,500 or higher/lower. This is specific to your policy, so the limits may be different for your situation. The package includes coverage for Medical Benefits, Income Loss, Accidental Death, and Funeral Benefit. The Accidental Death and Funeral Benefit portions of the coverage are subject to their specific limits and the other limits are defined by the policy.

Specific to your question, we must first state this: COVERAGE LIMITS, DEDUCTIBLES, AND CERTAIN EXCLUSIONS ARE LIMITED TO THE TERMS AND CONDITIONS CONTAINED IN YOUR POLICY. PLEASE READ YOUR POLICY FOR DETAILS. THIS WEBSITE IS FOR INFORMATION PURPOSES ONLY.

With what you provided, the $100,000 overall limit typically is an aggregate (the maximum amount an insurance company will pay during the policy). Therefore when there is a claim, each benefit is paid to its limit (i.e. funeral benefit is capped at $2,500, accidental death benefit is capped at $10,000). The total ever available under this coverage would be $100,000.

So, yes if the claim paid the full $2,500 for funeral benefit and the full $10,000 for accidental death benefit then the remaining available limit would be $87,500. If your FPB-Medical Benefit has a cap, it would be "capped" at that amount.

Typically the benefit cannot exceed a period of 3 years and the insurance provider will only pay for expenses or loss incurred within three years from the date of the accident. This is specific to your individual policy, so ask your agent or read your policy for specifics.

Please leave a comment with additional inquiries specific to this request.

Comment Update: If the funeral benefit or accidental death benefit were not needed AND if there is no cap/limit on the medical then the full FPB limit would be available ($100,000 in this example).

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