In the State of Oregon, if you have auto insurance (non-commercial), then you have a coverage known as Personal Injury Protection, commonly referred to as PIP. How care we be sure? It’s the law. So what is it?

What is PIP?

PIP is a no-fault healthcare and wage loss coverage. From the Oregon Insurance Division website, we find this: “PIP is Oregon’s version of no-fault insurance. It allows you and your passengers, regardless of who caused an accident, to have insurance coverage for ‘reasonable and necessary’ medical, dental, hospital, surgical, ambulance, and prosthetic services incurred within one year after the date of an injury up to a maximum of $15,000. In Oregon, minimum PIP benefits include limited coverage for loss of earnings, funeral expenses, and essential services, and child care.”

What does this mean for you?
Regardless of fault and determination of liability, you have immediate access to insurance to help pay medical bills, as described above, up to the PIP limit. While insurance companies may be haggling over where fault lies, and how much money to pay in damages, PIP will begin paying – prior to settlement – so that the injured parties do not become buried under a pile of unpaid medical bills. While the state mandated limit is $15,000, you may increase this limit with your company to provide an even greater cushion.

PIP will begin paying – prior to settlement

Is PIP solely for automobiles?
One of the nice features concerning PIP is that is protects you while a pedestrian or bicyclist as well – assuming your accident involves being hit by an Oregon registered private passenger vehicle. That is, should a car hit you while you are riding your bike, your PIP comes into play.

…protects you while a pedestrian or bicyclist as well

What about for motorcyclists?
However, a drawback is that PIP has a statutory exclusion for motorcycles. Some insurance companies will offer relatively low levels of coverage for motorcycles, but it is not state mandated. Call it prejudicial, but motorcyclists do not have access to the same PIP allowances afforded to other vehicles.

What about loss of income or wages?
As mentioned before, PIP also provides for loss of earnings if your injury prevents you from returning to work. There are certain requirements for this, and coverage is limited to 70% of wages, up to a maximum benefit of $3,000 per month, for 52 weeks.

…for loss of earnings

Are there time constraints?
It is important to realize, PIP coverage is limited to one year from the time of the accident. Accordingly, a PIP claim should be filed through your insurance company as soon as you realize that accident related injuries are going to need medical attention. Your insurance agent can provide you with the claim information which you’ll pass onto to medical providers, and your billing will be sent directly to the insurance company.

So, is PIP the perfect insurance coverage?
No doubt, PIP is a great coverage to have. However, to assume everything PIP-related works like a well-oiled machine is not realistic. Note from the earlier state referenced explanation – PIP coverage is for reasonable and necessary services. What one company considers reasonable, another may not. What you think is necessary may prove a sticking point for the insurer. How does this play out? Well, let’s say you feel it was essential to receive chiropractic care over the course of 10 weeks, and later find out the insurance company did not agree that chiropractic treatment (or massage, or acupuncture) was necessary…or reasonable. In other words there is no guarantee that the insurer will pay simply because you have the coverage.

Do PIP recipients ever experience settlement surprises?
At the time of claim settlement, if the other party in the accident is found liable, your PIP carrier will demand reimbursement from that person’s insurer. Knowledge of this is critical in determining an equitable settlement. If your insurer paid out $15,000 in PIP, and the other party’s insurance company sent you a check for a $9,000 settlement… it’s important to understand that your insurance company has a right to collect from you. From where does the missing $6,000 come?

…it’s important to understand that your insurance company has a right

In conclusion, PIP is a very nice feature of insurance we enjoy in the State of Oregon. That being said, the negotiation of claims settlement can prove confusing, overwhelming, and sometimes bizarre. Encouraging your insurance company to pay what you consider to be a necessary and reasonable medical treatment may appear an impossible task. Having an advocate in your corner who is watching out for your best interests, and feeling confident that you have an expert who understands the process proves invaluable during the stress following an injury accident.

…have an expert who understands the process

As a contingency fee based attorney, you will pay me nothing out-of-pocket for my services. My fee comes directly out of the settlement amount I negotiate on your behalf. Please feel free to contact me should you have questions about personal and accident injury claims.