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South Carolina high court holds med pay insurers owe only expenses paid

9/8/26

By: Shawn Bingham

Jones v. Progressive N. Ins. Co., 447 S.C. 555, 929 S.E.2d 398 (2026)

In Alexis Jones v. Progressive Northern Insurance Company, the Supreme Court of South Carolina addressed the interpretation of “expenses incurred” within an auto insurance policy’s medical payments (“Medpay”) coverage part. Alexis Jones, who was injured in an automobile accident, received medical treatment totaling $27,786.17. However, as a Medicaid recipient, her medical providers accepted a reduced payment of $1,323.60 from Medicaid as full satisfaction of her medical bills. Despite the Medicaid reductions, Jones sought the full $10,000 in Medpay coverage from her insurer, while the company paid only the $1,323.60 that Medicaid had covered.

Jones filed a lawsuit against Progressive for breach of contract, arguing that she was entitled to the full policy limit. The trial court ruled in her favor, interpreting the term “incurred” as ambiguous and adopting the interpretation most favorable to the insured. The court found that Jones incurred the full amount charged at the time services were rendered, entitling her to the full reimbursement under the policy. Progressive appealed, and the court of appeals affirmed the circuit court’s decision.

The Supreme Court of South Carolina reversed the Court of Appeals’ decision, holding that the term “expenses incurred” was unambiguous. Jones incurred only expenses in the amount that Medicaid had paid, as she had no obligation to pay more than that amount. Consequently, the Court concluded that Progressive was not liable for additional Medpay beyond the $1,323.60 Medicaid paid.

Jones is a significant decision for personal automobile insurers because it is one of the few cases nationwide to interpret the meaning of “incurred” charges in the context of a MedPay policy. Insurers writing personal auto business in South Carolina should consider revisiting their claims-handling practices and underwriting guidelines in light of this favorable precedent. And given the limited authority addressing this issue, this state supreme court decision provides strong persuasive authority for courts in other jurisdictions.

For more information, please contact Shawn Bingham at shawn.bingham@fmglaw.com or your local FMG Law attorney.

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