How Does Personal Injury Protection (PIP) Insurance Work in Oregon?

So you’ve been in a car accident. You’ve escaped the carnage with only minor injuries and a twisted metal heap that used to be your car. No matter the impact of your injuries however, you’re now faced with a mountain of medical bills, have missed 3 weeks of work, and owe your babysitter a mint for taking care of Kenny while you were recovering in the hospital.

You’re in luck however: there is this thing called Personal Injury Protection Insurance – or PIP. And whether you knew it or not – you’ve already paid for it, and will be able to reap the benefits. How does it work here in Oregon? Let me explain.

PIP insurance helps with injuries

What is PIP Insurance?

Personal injury protection insurance – also widely known as PIP – is what I call “health insurance for the car”. PIP pays your medical expenses, replaces lost income, and takes care of other expenses when you are injured in a car accident. Every auto insurance policy in Oregon must have PIP coverage included, with limited exceptions. Here’s how much PIP coverage you need to buy.

How Does PIP Insurance Work in Oregon?

Essentially, there are 4 types of injured people who can collect on PIP insurance:

  • Your insurance company will pay PIP if you were injured while driving your own car.
  • If you were injured while being a passenger in someone else’s car, their insurance company will pay PIP.
  • Even pedestrians and bicyclists injured by cars can collect PIP from their insurance company. Or, in certain cases, from the insurance company of the owner of the car that hit them. Note that the definition of “pedestrians” includes bicyclists.
How does PIP insurance work in Oregon for bicyclists

What Does PIP Insurance Cover?

In Oregon, PIP insurance covers all of the medical and incidental costs you incur from a car accident – outside of actual damage to your car and property.

  1. Medical Expenses: PIP insurance will pay for the medical expenses you incur as a result of a car accident. This includes all treatment received within 2 years of the accident, and up to the PIP limits of your policy. Oregon law requires PIP policies to pay for a minimum of $15,000, but it’s a good idea to increase your medical policy limits to $100,000.
  2. Lost Income: PIP insurance will also cover 70% of your lost income if you were off work for at least 14 days because of your injuries. The maximum reimbursement is  $3,000 per month. PIP will pay for up to 52 weeks of lost income.
  3. Help Around the House: If you were not employed when the accident occurred, your injuries disabled you for at least 14 days, and you had to hire someone to help perform “essential services” around the house, PIP will pay $30 per day.
  4. Funeral Benefits: $5,000 for a funeral, incurred within one year of the accident.
  5. Childcare Benefits: PIP insurance is also there for you to help out with Kenny’s childcare costs! They will reimburse you $25 per day – up to a $750 maximum – if you were hospitalized for more than 24 hours and had a minor child. The reimbursement period begins after those 24 hours, and continue until you can return to work or are no longer disabled.

Will PIP Pay Out For All of My Medical Expenses? 

Yes – with a few minor exceptions:

  1. Deductible: PIP may not pay for the first $250 in medical expenses if your PIP policy has a deductible.
  2. PIP Fee Schedule: Medical providers cannot force PIP to pay the amount of a bill. Rather, they have to accept the amount that is set by the Oregon PIP fee schedule. The providers have to write off the balance, and cannot bill you for that.
  3. Reasonable and Necessary Medical Expenses: PIP pays only for reasonable medical expenses associated with a particular car accident. If you had any other lingering medical issues you’re getting treatment for at the same time, you cannot include the bills for that into your PIP insurance claim.

By now you’re maybe wondering too: can a doctor refuse to accept my PIP Insurance? The answer is unfortunately “Yes”. They are not obligated under law to accept PIP insurance and can indeed decline it. So it’s generally best to call beforehand and make sure they will accept the insurance before you get treated by them. If they refuse to accept PIP and you pay them directly, you can seek reimbursement from PIP.  Note however that there’s a chance you may not get reimbursed in full. Your PIP insurance is only required to pay the amount a provider is authorized to bill by the PIP fee schedule.

What does PIP insurance cover? Medical expenses and more

How to Collect PIP Insurance

The process to collect on your PIP insurance is mostly pretty straight forward:

  1. Call the PIP insurance company and make a claim. Remember that you will need the PIP policy number on hand to set up the claim.
  2. The insurance company will give you a claim number, and the name and contact information for your assigned claims representative.
  3. When you go to see a doctor, ensure they accept PIP before you treat with them. 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.

Additional PIP Medical Coverage Rules

There are several other significant rules related to PIP insurance you need to consider.

  1. What Do I Do if I Run Out of PIP Medical Benefits? You can sometimes find another policy that will provide PIP benefits. 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 don’t have your own PIP insurance, 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. Be sure to check with your health insurer.
  2. Can PIP Require Me to See a Doctor of Its Choosing? Yes. Your insurance company may require you to attend a medical examination to determine whether the treatment is indeed reasonable or necessary. This is sometimes called an independent medical exam.
  3. Can PIP Have My Medical Records Reviewed? Yes. Frequently and before cutting a check, your PIP insurance will have your medical records reviewed by one of its employees to determine whether a medical treatment was indeed reasonable or necessary. Sometimes, they hire this out to a third party medical record or bill review service.

What to Do if Your Personal Injury Claim is Denied

It can happen that your insurance company denies your PIP claim. If all your submitted information was accurate, you might want to look at any of the following scenarios:

  1. Can PIP Refuse to Pay My Medical Bills? Yes, they can. It’s within their rights to refuse payments on any medical bills associated with treatments that were not “reasonable or necessitated”.  Remember, they only pay for injuries sustained in a car accident. All charges are presumed to be reasonable and necessary, so the insurance company must show some evidence to support their refusal. They need to provide you and your medical provider with a written refusal notice within 60 days of receiving the bill.
  1. What Should I Do Have PIP Refuses to Pay for My Medical Treatment? Contact a specialized car accident lawyer who is fluid in insurance law immediately to discuss your options. When choosing your personal injury lawyer, be sure they’re local and have plenty of experience with court cases.

If you need help wrangling your insurance company – Gary R. Johnson Law is here to help and advocate for you.

We never charge for an initial consultation, so give us a call today.