What are PIP Benefits? 15 Things to Know about Oregon PIP Benefits

If you have been in a recent car crash, you may have heard something about "PIP" benefits or "Personal Injury Protection" insurance.  As a Portland Oregon Personal Injury Attorney I can say the law mandating PIP benefits has assisted countless people that have been in a car crash in paying for reasonable and necessary medical treatment, lost wages, and funeral benefits. There are numerous things to know about PIP, but I did my best to boil it down to 15 things:

  1. What Are PIP Benefits?  "PIP benefits" is just a term for Personal Injury Protection benefits.  These benefits are "no fault" benefits that are provided by an insurance company that issued an automobile insurance policy in Oregon.  However, many self insured companies don't have PIP Benefits.  Companies and Entities such as Tri-Met, Police and Fire Departments, Taxi Companies typically do not provide PIP benefits.
  2. Can I Get PIP Benefits if I caused a Car Crash?  Yes, PIP benefits are "no fault" meaning that they provided to people involved in any vehicle crash regardless of fault. 
  3. Can I Get PIP Benefits If I was hit by a Car While Riding a Bike?  Yes, but the bad driver's PIP benefits are the last insurer to pay.  Usually if the injured person has either health insurance, car insurance, or both, those policies will pay first.  If there are any amounts still owed to medical providers after those insurers pay then the bad driver's PIP pays.  If you don't have health insurance, car insurance, or neither then the bad driver's PIP pays.
  4. Can I get PIP if I was a Pedestrian that was hit by a Car?  Yes, they are the same benefits you receive as if you were riding a bicycle.   (see question 3 above)
  5. Can I get PIP benefits if an insured Vehicle never Collided with me or My Vehicle?  Maybe,  there have been cases litigated over these issues where  a person claimed  PIP benefits but they were not injured in a typical car crash (i.e. injured in drive by shooting.)   These cases are very fact specific and there is not a clear answer.  Most likely an insurance company would deny PIP coverage and force the injured person to sue for benefits. 
  6. What Are the Exact PIP Benefits I am Entitled To?  The specific PIP benefits you are entitled to may vary based on the language of your insurance policy.   However, Oregon Law provides the minimum requirements for all PIP benefits.  The most common minimum requirements are:
    1. $15,000.00 for reasonable and necessary crash related medical treatment incurred up to two years from the date of the car crash;
    2. 70% of Lost Wages, or a maximum of $3,000.00 per month, if you miss 14 or more days of work due to crash related injuries;
    3. Reasonable and Necessary Funeral expenses, up to $5,00.00 if the expenses are incurred within one year of the crash;
    4. Child Care costs if injured person is hospitalized for more than 24 hours, but the maximum that will be paid is $25.00 per day for a total of $750.00.
  7. Does the $15,000.00 in PIP Medical Benefits Pay for Chiropractic Treatment, Physical Therapy, or Acupuncture?  Typically yes.   As long as the medical treatment is reasonable and necessary and related to the crash,  the insurance company should pay up to $15,000.00 for one year of treatment.  However, insurance companies will often deny payment for non-traditional treatment such as acupuncture or chiropractic treatment.   If that occurs call me at 503.224.1658 to discuss how to get those bills paid by the insurance company. 
  8. My Insurance Company Sent me a Letter Saying They Won't Pay Anymore Medical Bills, Can they Legally Do That?  Maybe,   Insurance companies often cut off people's PIP medical benefits.  This most often occurs when a car crash causes soft tissue injuries, or whiplash, to a person.  The insurance companies usually have a blanket cut of date for 12 to 16 weeks after the crash.  Then they send the injured person a letter noting the additional treatment is not necessary or reasonable, so they won't pay anymore.  If this occurs call me at 503.224.1658 to discuss your legal options to get those bills paid and continue to treat.  Sometimes an attorney can grease the wheels to get the bills paid and allow you to continue to treat.
  9. My Insurance Company Wants to Send Me to A Doctor, Can They Do That?  These defense medical exams (DME's) are called independent medical exams (IME) by the insurance companies.  Most policies and Oregon Law allows the insurance company to send you to a doctor.   This may be a good idea in theory, but in my experience Insurance companies use this law to prevent many injured people from receiving the medical care.   The way this works is the insurance company will hire a doctor or medical provider with the goal of cutting off your benefits.  Many of these Dr.s make tens of thousands of dollars a year examining patients with the sole goal of providing the insurance company a report that justifies the insurance company cutting off your PIP benefits. The insurance companies often use the same doctors, so the Doctors become reliant on the extra income they are making from providing insurance company favorable reports.  Therefore, when the doctor receives a request for a DME they know they should write a report favorable to the insurance company to ensure they will get called by the insurance company again. This is the vicious cycle that continues and provides insurance companies the ammunition to terminate your PIP benefits.
  10. Why Does the Insurance Company Want to Cut off PIP Medical or Lost Wage Benefits?  The short answer is MONEY.  You have paid insurance premiums for years and are trying to get the benefits you have paid for. However, the insurance company loses money any time an insurance company pays PIP benefits.  The way insurance companies increase their profit margin is they have to limit the amount of benefits they pay out. Insurance companies are businesses and their goal is to make as much money as possible.  Your desire to obtain your $15,000.00 in PIP benefits cuts into the insurers bottom line.   
  11. Does the Insurance Company Send a Check to Me or to My Medical Provider?  It depends.  Many insurance companies directly bill the medical provider.   Some will reimburse you for your expenses.  Most medical providers will send the bills directly to the insurance company and the insurance company will pay them directly.  If you have already paid then they may send you a check to reimburse you.
  12. How Long Will The Insurance Company Pay My Reasonable and Necessary Medical Bills? Up to one year from the date of the incident or until the insurance company claims the bills are no longer reasonable or necessary (see Question 8-10 above).
  13. I Am Self-Employed, Can I Get Wage Loss?  Yes, but the insurance companies usually make it more difficult for you to verify your income.  You may need the assistance of a Personal Injury Attorney like myself.
  14. Where Can I find the Actual Law Noting What The Minimum Requirements for a PIP Policy Are?  Oregon Revised Statute 742.524 (ORS 742.524) is the law that mandates the minimum benefits. You can purchase more than the minimum.
  15. What Can I Do If My Insurance Company Won't Provide PIP Benefits?  If your insurance company cuts off your PIP Medical Benefits, your PIP Lost Wage Benefits, or other PIP benefits for any reason, you should call a lawyer immediately.   Lawyers such as myself are happy to take many of these PIP cases because if we win the insurance company has to pay the cost of the lawsuit and the attorney fee.  This allows you to get your PIP benefits with little financial risk to yourself.

If you or someone you know has any questions about PIP call Portland Oregon Personal Injury Attorney Jeremiah Ross at 503.224.1658 for a free personal injury consultation.  

IMPORTANT LEGAL STUFF:  Please remember all situations vary and this blog post is for informational purposes only.  It is based on my opinion, personal experience, and interpretation of the law.  However, the law changes and insurance companies may have a perfectly good lawful reason for cutting off PIP benefits.  That is why it is best to consult with an attorney to determine your rights and obligations.  Also, remember the law is constantly changing so this post may be outdated and based on law that has changed.  Please review the current state of the law.