Does my health plan cover medical care for a personal injury claim or denied Workers' Compensation claim?

We are addressing both the Oregon Workers' Compensation claim and the Oregon and Washington personal injury claim.  So, where does health insurance fit in to each of these claims.  Let's start off with the personal injury claim, and then address workers' compensation.

In an injury claim, you may have PIP if your car is insured in Washington, and you will have PIP if insured in Oregon.  PIP, or "personal injury protection," includes  coverage for medical expenses.  However, if you are seriously injured, you may use the available PIP coverage.  If this happens, you have "exhausted" your PIP coverage, and if you have health insurance, that health plan should step up and process the remaining medical bills.  Your health plan is going to want verification that you have used all your PIP coverage, and may plans will require that you sign an agreement that it will be reimbursed for medical benefits provided out of any settlement.

On the Oregon Workers' Compensation end of things, your medical providers cannot collect any bills while the appeal of the denied claim is pending.  However, you may need to treat for your injuries, and if you have a private health plan, it will likely cover your medical expenses so you can treat your injury, and get back to work sooner.  Like a personal injury claim, your health plan may have you sign an agreement that provides you will reimburse the health plan for medical expenses paid if you resolve your claim by settlement.  If you prevail on the claim, the medical provider usually reimburses your health plan, and then bills the workers' compensation carrier.

If you have questions about medical bills and a personal injury or Oregon Workers' Compensation claim, call us at 503 325 8600.  We work with clients on these issues every day.

Joe Di Bartolomeo
Connect with me
Top-rated Personal Injury Lawyer Helping Oregon and Washington Families