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.
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. 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. Who should I see for pain and injuries sustained from the crash?
A motor vehicle crash can cause severe injuries and often always involves whiplash injuries. The treatment recommended for whiplash injury varies widely among health care practitioners.
- Emergency rooms around the country, the common advice is to go home, apply an ice pack, take anti-inflammatory medication, and to consult with the family doctor if symptoms persist beyond two weeks. Unfortunately, this advice is probably responsible for at least some of the more than 30% of whiplash victims who never fully recover or the 10% or more who become disabled.
- Acupuncture Traditional needle acupuncture is often helpful in relieving the pain of an acute cervical spine injury such as whiplash. It has also been shown to be of benefit for chronic neck pain.
- Chiropractic The primary tool of modern chiropractors is spinal manipulation or, in the parlance of the profession, spinal adjusting. Chiropractors also utilize a variety of physical medicine and rehabilitation approaches, along with nutritional advice to strengthen and balance the body. They may utilize traditional modalities such as ultrasound, diathermy, microcurrent stimulation, laser therapy, traction, and heat and cold applications in addition to spinal manipulation.
- Medicine There are many different medical specialties, but the specialties most likely to treat whiplash are general or family practice, orthopaedics, neurology, and physical medicine and rehabilitation, with the latter usually having the most to offer these patients. Beyond pain management, medical practitioners may refer patients for a number of sessions of physical therapy, which might include exercises, stretching, deep tissue massage or mobilization, and many other modalities.
- Multidisciplinary centers Pain treatment centers are examples of multidisciplinary centers, and usually employ a variety of practitioner types and therapists. This might include neurologists, physiatrists, chiropractors, physical therapists, orthopaedic surgeons, exercise physiologists, and psychologists or psychiatrists. It is important to watch runaway costs when more consults or treatment than might be necessary are provided. Similar working relationships and provider networks can exist less formally in which the primary treating provider manages care by referring to the appropriate specialists around town when necessary and appropriate. In many cases the primary treating practitioner might be a chiropractor or a family practitioner
*A recent comparison of medicine, acupuncture, and chiropractic care Comparing, in a randomized trial, medication (Celebrex, Vioxx, or paracetamol) to acupuncture and spinal manipulation over the course of 9 weeks in persons with chronic spinal pain (neck to low back pain included), the authors demonstrated a rather profound superiority in chiropractic spinal manipulation. The exception was for neck pain in which acupuncture was found to be superior on the basis of Neck Disability Scores. The average period of chronicity was 4.5 years in the medicine group; 6.4 years in the acupuncture group; and 8.3 years in the chiropractic group. After 9 weeks of care, spinal manipulation had achieved asymptomatic status in 27%, compared to 9.4% for acupuncture and only 5% for medicine. Patients were allowed to change therapy groups if they perceived a lack of effectiveness in their current treatment group. Over the course of the 9 weeks, nine from the medical group, five from the acupuncture group, and two from the chiropractic group changed treatment types.