Cognitive Decline Diagnosis and Auto Insurance in Maryland

Maryland physicians are required under COMAR 11.17.02 to report patients diagnosed with conditions that may impair safe driving, including dementia, Alzheimer's disease, moderate to severe cognitive impairment, and uncontrolled seizure disorders. The report goes directly to the Maryland Motor Vehicle Administration's Medical Advisory Board, not to the patient or their family first. The physician submits a Physician's Statement form to the MVA within 30 days of diagnosis or upon determination that the condition has progressed to a level that affects driving ability. The driver is not required to consent to this report — Maryland law grants physicians immunity from liability for these disclosures. Once the MVA receives a medical referral, they send the driver a notice requiring a Medical Review. This letter typically arrives 2–4 weeks after the physician files the report. The driver has 30 days from the date on that letter to respond, or their license is automatically suspended.

The Medical Review notice requires the driver to submit updated medical records, often including a neuropsychological evaluation and a signed statement from their treating physician indicating whether they are medically cleared to drive. The MVA does not pay for these evaluations — the driver is responsible for all testing and documentation costs, which typically run $800–$1,500 for a full cognitive assessment. The Medical Advisory Board reviews submitted documentation and determines one of four outcomes: full clearance with no restrictions, conditional clearance with restrictions (daytime-only, geographic radius limits, or required annual re-certification), license suspension pending further evaluation, or permanent revocation. Most dementia-related referrals result in restrictions rather than immediate revocation if the diagnosis is early-stage. If restrictions are imposed, the MVA issues a new license with the restriction codes printed on the front. The driver must carry this restricted license at all times, and violation of the restrictions is treated as driving without a valid license — a criminal offense with potential jail time and automatic license suspension.

Maryland carriers do not receive automatic notification from the MVA when a medical referral is filed or a restriction is imposed. However, at your next policy renewal — which for most seniors occurs every 6 or 12 months — the carrier runs an MVA record check and will see any restriction codes or license status changes that have occurred since the last renewal. Once a carrier identifies a license restriction related to cognitive impairment, they typically take one of three actions: non-renew the policy with 45–60 days' notice, increase the premium by 20–60% depending on the restriction type, or require annual medical certification as a condition of continued coverage. Non-renewal is the most common outcome for dementia-related diagnoses, even if the driver retains a restricted license. If the MVA suspends or revokes the license, the carrier will cancel the policy mid-term for material misrepresentation if the insured continues to drive, or convert the policy to a non-driver rate if the vehicle remains registered but unused. A non-driver policy costs 40–70% less than a standard policy but provides no liability coverage for any vehicle operation.

Drivers with MVA-imposed medical restrictions are classified as high-risk by most standard carriers. In Maryland, this moves the driver into the assigned risk pool or the non-standard auto market, where premiums are 50–150% higher than standard rates for comparable coverage. Maryland does not require carriers to offer coverage to drivers with cognitive impairment diagnoses or related restrictions. Most standard carriers (State Farm, Allstate, GEICO) will non-renew at the end of the current term. Non-standard carriers such as Progressive's high-risk division, Dairyland, or The General may offer coverage, but at significantly elevated rates and often with reduced liability limits. If the restricted driver shares a household with another licensed driver, some carriers will allow the restricted driver to be excluded from the policy entirely. This requires the restricted driver to sign an exclusion form, and the vehicle must be titled and primarily operated by the non-excluded driver. If the excluded driver operates the vehicle, the policy provides zero coverage for that incident — the excluded driver is personally liable for all damages.

Maryland is an at-fault state and does not require Personal Injury Protection on auto policies. Most senior drivers carry liability-only coverage or liability plus comprehensive on paid-off vehicles. If a senior driver with a cognitive impairment diagnosis causes an accident, their liability coverage pays for the other party's injuries and property damage — but their own medical bills fall to Medicare or their supplemental health insurance. Medicare will pay for accident-related medical treatment, but if the accident was caused by the Medicare enrollee and resulted from violating a license restriction or driving after revocation, Medicare can assert a recovery claim against any liability settlement or judgment the driver receives. This is rare but has occurred in cases involving serious injury accidents where the at-fault driver's cognitive impairment was documented prior to the crash. If the senior driver carries optional Medical Payments coverage, that coverage pays regardless of fault and coordinates with Medicare as secondary coverage. Medical Payments coverage of $5,000–$10,000 costs $40–$80 per year in Maryland and can cover co-pays, deductibles, and services Medicare does not fully reimburse.

Respond within the 30-day window stated on the notice. Missing this deadline results in automatic license suspension, which triggers immediate policy cancellation and requires full reinstatement fees and proof of future financial responsibility before the license can be restored. Schedule the required medical evaluation immediately — neuropsychological testing often has a 4–6 week wait for appointments in the Baltimore and DC metro areas. If the 30-day response window does not allow time for testing, contact the MVA Medical Review Unit at 410-787-7510 to request an extension before the deadline passes. Notify your auto insurance carrier as soon as you receive the Medical Review notice — not after the MVA makes a determination. If the carrier discovers a restriction or suspension at renewal without prior disclosure, they may deny claims retroactively or cancel the policy for material misrepresentation. Proactive disclosure allows you to explore restricted-driver coverage options or arrange for a named-driver exclusion if appropriate.