What is personal injury protection insurance in Oregon? Personal injury protection insurance, a.k.a. PIP, is what I call “health insurance for the car”. PIP pays your medical expenses, lost income, and other benefits when you are injured in a car accident. Every auto insurance policy in Oregon must have PIP coverage with limited exceptions. ORS 742.520(1).
Who can collect PIP? Anyone who is injured in a car accident can collect PIP from the auto insurance company for the owner of the car in which they were riding. ORS 742.520(2)(a). If you are injured while driving your car, your insurance company will pay PIP. If you are injured while a passenger in someone else’s car, their insurance company will pay PIP. ORS 742.520(2)(b).
Can pedestrians injured by cars collect PIP? Yes pedestrians and bicyclists injured by cars can collect PIP from their insurance company or, in certain cases, from the insurance company for the owner of the car that hit them. ORS 742.520(2)(b). (The definition of pedestrians includes bicyclists. ORS 742.518(6).)
What does PIP pay? Medical Expenses, Lost Income, Help Around the House, Childcare, Funeral Expenses.
Will PIP pay for all of my medical expenses? Yes with a few exceptions:
Can a Medical Provider Refuse to Accept PIP? Yes a medical provider can refuse to accept PIP so make sure they will accept PIP before you treat with them. If they refuse to accept PIP and you pay them directly, you can seek reimbursement from PIP but you may not get reimbursed in full as PIP is only required to pay the amount a provider is authorized to bill by the fee schedule. ORS 742.525.
How do I get My Medical Bills paid by PIP? Call the PIP insurance company and make a claim. You will need the PIP policy number to set up the claim. They will give you a claim number and the name and contact information for the claims representative handling the claim. When you go to see the doctor, make sure they will accept PIP before you treat with them. When you get to the doctor’s office, tell the person you check in with to bill PIP and give him or her the PIP claim number and name and contact information for the claims representative handling the claim.
What Do I Do if I Run Out of PIP Medical Benefits? If you use all of the PIP under the policy, you can sometimes find another policy that will provide PIP. For example, if you were injured as a passenger PIP will first be provided under the policy of the vehicle owner. If you use all of those PIP benefits, you can then make a claim for PIP under your own insurance policy if you have one. If you can’t find PIP under another policy, you can try to get your health insurer to pay your medical expenses. Beware that some health insurers will not pay for medical expenses necessitated by a motor vehicle accident that was someone else’s fault. Check with your health insurer.
Can PIP Refuse to Pay My Medical Bills? PIP can refuse to pay medical bills for treatment that was not reasonable or was not necessitated by injuries sustained in a car accident but must have some evidence to support its refusal to pay. PIP must provide you and your provider written notice of its refusal within 60 days of receiving the bill. ORS 742.528. The charges are presumed to be reasonable and necessary unless PIP notifies the provider within 60 days that it is refusing to pay the expenses. ORS 742.524(1)(a).
Can PIP Require Me to See a Doctor of Its Choosing? Yes PIP may require you to attend a medical examination to determine whether medical treatment is reasonable or necessary. ORS 742.520(7)(b) and ORS 742.518(1). This is sometimes called an independent medical exam.
Can PIP Have My Medical Records Reviewed? Yes PIP can have your medical records reviewed by one of its employees or a third party medical record or bill review service to determine whether medical treatment is reasonable or necessary. ORS 742.520(7)(b) and ORS 742.518(1).
What Should I Do Have PIP Refuses to Pay for My Medical Treatment? Contact an attorney immediately to discuss your options.
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Gary R. Johnson is a Central Oregon attorney who has handled personal injury cases since 1994.