When you’re in an accident, one of the first issues you have to deal with is how to pay the medical bills. The medical bills may be small if you didn’t get hurt very badly. Other times, people get severely injured and the bills are huge. In Oregon, all car insurance policies are required to provide “Personal Injury Protection,” also known as PIP. This insurance coverage on your policy will pay for some your bills up to your PIP limits.
Each of the following different types of benefits come from different envelopes of money. That means if you exhaust your medical benefits, you can continue to collect lost wages—that is a different benefit, so it comes from a different envelope.
Medical Benefits
The minimum amount of PIP medical benefits allowed by law is $15,000 that must cover at least one year. PIP medical benefits must last through either the maximum amount of benefits (the limit) or through the end of the first year after the accident. Some insurance policies provide PIP medical benefits that cover more than one year or more than the minimum of $15,000. If you use up all your medical benefits, the policy is “exhausted.” Any amount of benefits you do not use in the time limit “expire” and are no longer available to you. Because of this, it is important to get all the medical treatment you need and your doctors recommend in that first year. That first year is also when the treatment probably will do your body the most good, which is the most important reason to get treatment early.
PIP medical benefits are not limited to certain providers like your regular health insurance is, so you can go see your choice of doctors and get your choice of treatment, including alternative treatments like chiropractic services, physical therapy, massage, acupuncture, and others. You do not need pre-approval from your insurance company to go see a doctor. For expensive procedures, your doctor may want to request pre-approval, but it is not required for you to use your PIP benefits.
Lost Wages
PIP benefits will also pay lost wages. The rules for paying lost wages can get a little complex because the Oregon statute that sets out the rules is also a little complicated. PIP wage loss includes wages, salary, tips, commissions, professional fees, business profits, and even unemployment benefits. To qualify for a wage loss claim you must miss work for 14 consecutive days (essentially two weeks in a row). After the first set of consecutive days, you can miss additional work sporadically (miss a day here or there) and PIP will pay those lost wages too. PIP will pay lost wages for up to a year of missed work—this means that you can miss 52 weeks of work and PIP will pay your wages, and the 52 weeks do not have to occur in the same year. Unlike medical benefits, PIP wage loss benefits do not expire at the end of the first year.
PIP wage loss benefits do have some additional limits. PIP will only pay 70% of the amount you would have earned for the time you lost. Also, PIP only has to pay $3,000 per month maximum.
Essential Services/Household assistance
If you do not work and are so injured that you cannot do things you used to—like housework or cleaning—PIP will pay for “essential services” up to $30 per day for up to 52 weeks. To qualify, you must be unable to do these tasks yourself for 14 consecutive days (two weeks in a row) and the person you choose to help you cannot be a relative or live with you.
Funeral Expenses
PIP benefits will also cover up to $5,000 in funeral expenses within one year of the motor vehicle wreck.
Child Care
If you do not work and have to be hospitalized for at least 24 hours, PIP will pay for child care, up to $25 per day, up to a total of $750. PIP will pay for this child care for as long as you are unable to return to work or as long as you are unable to perform “essential services.”
Availability of PIP Benefits
All the different types of PIP benefits are available to you regardless of whether you were at fault or someone else was at fault. This is considered a “no-fault” part of your policy. If you were not at fault, your PIP insurance company will seek reimbursement of the benefits that it provided to you. It can do this by seeking reimbursement from the at-fault party’s insurance company or if you make a claim against the at-fault insurance party, it may ask you to recover its payments. If you have been severely injured, there may not be enough insurance coverage to cover all your losses and PIP will not get paid back.
When dealing with severe medical conditions and injuries, you have more important things to spend your time on than figuring out which insurance coverage pays which bills, what the policy numbers are, and who you need to notify. If you have been severely injured, you should talk to an attorney. We can help you understand your rights in your free initial consultation.
