Oregon Personal Injury Protection Insurance (PIP)
All Oregon non-commercial auto insurance policies have no-fault Personal Injury Protection (PIP) healthcare and wage loss coverage. What this means is that if you are injured in an auto, bicycle, or pedestrian accident, your auto insurance provides a minimum of one year and $15,000 in no-fault medical coverage. In addition to medical coverage, your personal injury protection insurance provides wage loss coverage. This coverage is mandatory for all auto insurance, but not motorcycle insurance. Oregon Senate Bill 411 made a slight but important modification that extends PIP coverage for medical bills following an accident from one year to two years (the new law went into effect on January 1, 2016, effective on policies issued or renewed on or after that date).
Click on a question below to reveal the answer.
Q1: Who does personal injury protection cover?
Oregon personal injury protection insurance all of the occupants of the car. It also covers pedestrians and cyclists hit by a car. If you are on a bicycle or a pedestrian, your personal injury protection should pay your medical expenses if you are struck by a motor vehicle. If you do not have auto insurance and do not have health insurance, than the other driver's insurance should pay your medical bills.
Q2: What does Oregon personal injury protection cover?
It covers your medical bills related to the accident, up to one year or $15,000. Oregon Senate Bill 411 made a slight but important modification that extends PIP coverage for medical bills following an accident from one year to two years (the new law went into effect on January 1, 2016, effective on policies issued or renewed on or after that date).
It covers your wage loss up to $3,000 for 52 weeks.
It covers loss of essential services for up to $30 a day.
Q3. How much wage loss will my personal injury protection insurance pay?
You PIP insurance will pay up to 52 weeks of wage loss up to the maximum monthly amount of $3,000.
Q4. Will my insurance company pay all of my medical bills?
Your insurance company is required to pay all of your medical expenses within the first year that are reasonable and related to the accident, up to your policy limit ($15,000 for most people). This does not mean that they will pay these bills. Insurance companies do not pay bills if they don't have to. They can deny payment and send you to an insurance company doctor. The vast majority of the time these doctors say that your treatment is not necessary, that is why the insurance companies use these doctors rather than talking to your treating doctor.
Q5. What can I do if they refuse to pay my medical bills?
If the accident was not your fault, the best course of action is to pursue the at fault driver's insurance company for your medical expenses as well as your pain and suffering. If you were at fault, your only choice is to sue your insurance company or request arbitration. If the accident was your fault, you can sue your personal injury protection carrier and force them to pay your medical expenses.
Q6. Is there anything I can do to make it less likely that my personal injury protection will deny payment of my medical bills?
Yes. In my experience, your bill are much less likely to be denied if they are from a medical doctor (MD or DO), than if they are from a chiropractor, naturopath, massage therapist, or acupuncturist. There are many honest providers out there who are not medical doctors, but there are also a number of providers who just want to run up a bill. If you are seeing a chiropractor who says you need to treat 5 times a week, there is a very good chance that your personal injury protection is going to cut you off.
Q7. Do I have to pay my insurance company back for my personal injury protection benefits?
Whether or not you have to pay the benefits back out of any settlement or award depends largely on what your attorney does early on in your case. Most of the time I can force the insurance companies to elect to pay me a fee to recover the medical expenses or waive recovery out of my client's settlement or award. Insurance companies do not want to pay me a fee, so the vast majority of the time the insurance companies do not require any repayment by my clients.
Q8. What happens if my medical expenses exceed my personal injury protection coverage?
If you have healthcare insurance, your healthcare insurance will usually pay any additional amounts. If you do not have healthcare insurance, you will be billed personally for any amounts in excess of your PIP coverage. Oftentimes I can work with providers to get them to wait for payment until the case is resolved.
Q9. Am I limited to what doctors I see?
No. If you have Kaiser, you can go outside the Kaiser system. Your Oregon personal injury protection insurance is required to pay for any reasonable and necessary treatment that you have. You get to choose who your doctors are.
Q10. How much personal injury protection insurance should I buy?
That depends on whether or not you have healthcare insurance. If you have good healthcare insurance with low co-pays, than buying more than the minimum PIP coverage is not as important. If you do not have healthcare insurance, than you should buy more than the minimum PIP coverage.