At its core, auto insurance is in place to help you avoid going broke after an accident. While there will be a lot to deal with, the priority should be to make sure any medical expenses related to your injuries are covered. You don’t want the stress of financial worries compounding your recovery.
Personal Injury Protection (PIP) can provide that coverage, and it is mandated by the state of Oregon.
The important thing to remember about PIP is that it is a “no-fault” insurance policy.
That means you’ll be covered for medical expenses and lost wages no matter who is to blame for the accident. The coverage also extends to passengers and pedestrians, and most PIP policies offer coverage without deductibles or co-pays.
Of course, even though the insurance is “no-fault,” there could still be issues with the insurance carrier with regard to the extent of your injuries. In an effort to minimize their payout, they might assert you’re not as injured as you claim. When a dispute like that arises, it’s a smart move to get help from an experienced Portland car accident lawyer.
That attorney will be in the best position to provide you with guidance about what to do when an insurance carrier attempts to lowball your payout.
Before that happens, it will help to understand how personal injury protection insurance works in Oregon.
Mandatory Personal Injury Protection Benefits in Oregon
According to Oregon law, it is illegal to drive without liability coverage. No driver sets out to intentionally crash their car, but accidents happen, and that is why liability insurance exists.
These are the auto insurance mandates in Oregon:
Bodily injury and property damage liability
- $25,000 per person
- $50,000 per crash for bodily injury to others
- $20,000 per crash for damage to others’ property
Personal injury protection
- $15,000 per person
Uninsured motorist
- $25,000 per person
- $50,000 per crash for bodily injury
Those are just the minimums. Many drivers opt for higher coverage for added protection.
Under the PIP umbrella of coverage, you can expect the following features to be paid out regardless of who is at fault in the accident:
- Medical Benefits: PIP covers “reasonable and necessary” medical, hospital, dental, and surgical expenses.
- Lost Wages: Reimburses 70% of lost income up to $3,000 per month. This is only applicable if you are unable to work for at least 14 consecutive days.
- Essential Services: Provides up to $30 per day for non-medical services you cannot perform, such as housekeeping or childcare. These benefits can be up to 52 weeks.
- Funeral Expenses: Covers reasonable funeral expenses up to $5,000.
- Pedestrian and Passenger Coverage: PIP also covers you if you are injured as a pedestrian, bicyclist, or passenger in another person’s car.
Calculating PIP Wage Loss and Disability Payments
In addition to your medical expenses, PIP also covers lost wages up to a point. First, you need to prove that you were employed at the time of the accident. You also have to have a doctor verify that your injuries are keeping you from returning to work for at least 14 consecutive days. That is the waiting period for the benefits.
After the two weeks, you will get 70% of your average gross monthly earnings up to a maximum of $3,000 a month. For instance, if you make $6,000 a month, 70% would be $4,200, but the most you would receive is the cap at $3,000.
The Relationship Between PIP and Your Liability Claim
Personal Injury Protection will help with immediate medical bills and wage losses while you navigate through the liability claims process. That can certainly provide a measure of comfort, but there are some important considerations.
First are the limits of your policy. If you’ve only taken out a policy for the mandatory $15,000, that is all you can expect to receive, regardless of the extent of your injuries or lost wages. The insurance company is only obligated to pay up to the policy limits.
If you make a liability claim against the at-fault driver, your PIP insurer has the right to be reimbursed for the money they paid you. That doesn’t mean you have to repay your insurance company.
Instead, they will attach a lien to your settlement.
For example, if your PIP pays $10,000 but your total bills are $15,000, you might receive that $15,000 from the at-fault driver’s insurance. However, your carrier will deduct the initial $10,000, leaving you with $5,000.
Yes, you can recover damages from your policy and the at-fault driver’s policy. This is known as stacking. However, you can’t be paid twice for the same expenses.
Ultimately, you’ll only receive what is due.
Dozier Law Group Can Help When Insurance Denies PIP Benefits
Even though you’ve paid your premiums and have been a loyal policyholder for years, your insurance can still deny your PIP benefits. If that happens, you need to review the denial letter to identify the reason. Sometimes, a policyholder might have let their policy lapse.
In that situation, the insurer would be justified in refusing to pay the PIP benefits, but that wouldn’t preclude you from filing a liability claim. If the insurer denies the PIP coverage because of a medical necessity issue, then you can make a formal appeal and be examined by an independent doctor to verify your claim.
At this point, you would benefit from speaking with the skilled personal injury attorneys at Dozier Law Group.
We have helped many clients navigate the challenges of stacked insurance claims.
We’ve also identified instances where the insurance company is acting in bad faith by unreasonably delaying or denying a rightful claim. In those instances, we’ve been able to support our clients by negotiating with insurance companies for a fair settlement or by taking them to court to compel them to act.
If you’re overwhelmed by the prospect of dealing with insurance companies after an accident, we can help. Call to schedule a free consultation to discuss your options.
Let’s find a solution together.