What is Personal Injury Protection?
Personal Injury Protection (PIP) is an extension of your car insurance policy that pays medical expenses, lost wages, and essential services after an accident. PIP is no fault insurance and is available to both parties in an accident, even the at fault party.
Who has PIP?
Probably you! Oregon Law requires all auto insurance policies to have Personal Injury Protection. If you have a Washington insurance policy you likely have PIP too. Washington auto insurance is required to provide PIP unless it is properly waived, which it rarely is. If you have a Washington auto insurance policy and your carrier insists you do not have PIP, you should consult an attorney to make sure that is accurate.
Who does PIP cover?
- The driver of a vehicle’s PIP policy covers all of the occupants of the car.
- If you are a pedestrian or cyclist and have auto insurance, your auto insurance’s PIP policy will cover you.
- If you don’t have auto insurance (or can’t otherwise get coverage), then your health insurance would be primarily responsible for the medical bills. However, the driver’s PIP policy will cover any out of pocket expenses, for example co-pays.
- If you don’t have auto insurance or medical insurance, the PIP of the other party will be the primary coverage.
How much does PIP cover?
In Oregon the minimum coverage for medical bills, wage loss, and essential services is up to $15,000.00, but only for 1 year after the accident (up to two years on policies written after January 1, 2016). It is possible through some carriers to purchase higher limits of PIP insurance.
What does PIP Cover?
- Medical Bills: PIP insurance will cover all medical bills that are reasonable and related to your accident.
- Lost Wages: PIP will pay your lost wages if you have a written note from a doctor saying you cannot work for 14 consecutive days. If you are on restricted duty for 14 consecutive days and your job cannot accommodate you, this benefit will also be triggered. However, PIP insurance will only reimburse you 70% of your income up to $3,000.00 per month. (This is also subject to the limits of your policy).
- Essential Services: If your injuries cause you to be unable to perform normal household duties such as cleaning, yard work, or cooking, PIP will pay up to $30 per day for you to hire someone.
- Child Care: In certain circumstances you can get some nominal reimbursement for child care.
How do I access my PIP benefits?
The first step is to open a claim with your insurance or with the party whose PIP coverage is primary. This process will require you to complete a PIP application. They will you give you a claim number. You will provide the insurance company name and claim number to your medical providers who will bill PIP directly. If you have already paid for some expenses, you can submit those bills to PIP for reimbursement. A Personal Injury Attorney can help you with this process.
NOTE: PIP will require you to send a Medical Release. Only send that release to PIP. Do not send a medical release to the at fault driver’s insurance. If you are using the at fault driver’s PIP, you must be provided two adjusters: one for PIP and one for the claim against the at fault party.
What should I do if PIP denies payment or cuts off my benefits?
Contact a Personal Injury Attorney for advice. Insurance companies don’t make money by paying claims and will try and pay as little as possible. Six months after PIP denies payment an attorney can sue the insurance company and may recover all owed medical bills and attorney fees on your behalf. They can also help you continue to receive the medical care you need by setting up an arrangement with your health care providers to continue to get medical care in exchange for payment once the money is recovered from the insurance company(s).
The PIP Independent Medical Exam (IME)
IME’s are not as independent as they sound and will likely not be favorable. If your PIP carrier wants to schedule you for an IME and you don’t have an attorney, now is the time to get one or consult with the one you have. Not doing the IME will guarantee your PIP benefits will be cut off. Whether or not you want to do the IME is fact specific and you should consult an attorney.
The Oregon insurance law, PIP (personal injury protection insurance), vehicle insurance, or other legal information presented here should not be construed as formal legal advice, nor the formation of the attorney client relationship. To get specific legal advice regarding your claim contact Jeff Siefman at Siefman Law LLC, or another licensed attorney in your state.
Jeff Siefman, Personal Injury Attorney at Siefman Law LLC.