Your Auto Policy Steps Up First
If you have been involved in an auto collision in Oregon, the first place to look for medical coverage is your own auto policy. If the policy is issued in the State of Oregon, then we know you have "personal injury protection" coverage also called "PIP." This is a no-fault medical benefit that will cover necessary medical care related to your Oregon auto collision injuries up to the coverage limits or within two years from the collision, whichever is reached first.
You may be in a collision where there is no personal injury protection claim. For example, Washington insurance statutes do not require insurers to sell personal injury protection to all motorists. When this happens, we often look to see if there are any auto policies in your household. Sometimes, an auto policy and your household will pick up or cover medical expenses under the personal injury protection coverage.
Here are basics on PIP coverage:
You need to file a PIP application, and sign an authorization so the insurance company can obtain your medical records. Here are other facts about PIP coverage:
The PIP is "no fault," so even if you are at fault, you are covered;
You are covered if you are a passenger;
You are covered if you are driving another person's car with their permission;
There are other benefits available, like disability, domestic care expenses, and child care;
The $15,000.00 is the minimum required coverage. There may be higher coverage
Another possible scenario involves pedestrian injuries. Unlike injuries to people riding or driving cars, the personal injury protection coverage for injured pedestrians does not come into play unless there are no other sources of health care coverage (like health insurance) to pay medical expenses.
Bottom-line: the first order of business is to find coverage for your medical expenses so you can worry about getting better, and not medical bills.
When Auto Policy is Not Enough
We have seen many cases where our client is seriously injured, and before they even reach the hospital (Life Flight), they have used all their auto policy medical coverage. In those cases, we look to our client's health care plan to cover additional expenses. In some cases, the hospital will choose not to bill the health care plan, but instead files a lien on the case, making sure that it is paid directly from any settlement or recovery you obtain from the at fault driver. When that happens, we work directly with the hospital to negotiate payment of the liens, sometimes obtaining a significant discount of the claimed amounts.
How Are Medical Expenses Handled With a Claim Settlement or Recovery?
When a claim is resolved by settlement or recovery at a trial or arbitration, you need to account for the medical expenses paid by your auto insurer or health plan. This is because Oregon law generally requires that out of any settlement, you to reimburse your auto policy for medical benefits it paid. Health plans will almost always include the same requirement. But remember, these are only general rules, and there are exceptions. Also, the law is always changing, so you should know your obligations before agreeing pay health plans or your auto insurer out of any money you recover from the other insurance company.
Medicare and The Oregon Health PlanMedicare and the Oregon Health Plan are government sponsored health insurers, and both require that you report your claim and any settlement of the claim. These agencies will calculate, based on their rules, how much you need to pay out of any settlement for health benefits you provide. Generally, the government sponsored health plans are not as flexible with negotiating reimbursement, but it does occur.
We have handled many cases for people with serious injuries and significant medical expenses. If you have questions about medical expenses related to your Oregon auto injury claim, contact us. We can help you know where you stand.