How do I get my medical bills paid?
If you have been injured in an car crash (including injuries as a pedestrian or as a bicyclist hit by a car), you are protected under the “Personal Injury Protection” (PIP) benefits of your own motor vehicle insurance policy. This means that your own car insurance will pay your medical bills, for up to at least the first two years after the collision, or $15,000, whichever is first. (Some insurance policies have PIP benefits that have higher limits than the minimum $15,000.) PIP will also replace your lost wages if you were regularly employed and are disabled from work for at least 14 days (ORS 742.520, 742.524). It will pay 70% of your gross earnings, up to $3,000 per month. PIP benefits may also pay for substitute services (paying someone to do household jobs that you otherwise would have done yourself), funeral expenses, and childcare. All of these benefits have specific conditions and limitations.
If you have exhausted PIP or were injured other than in an auto accident, you have other options.
Your personal health insurance will likely cover some or all of your medical bills, depending upon the coverage of your policy. Most health insurance policies require a co-pay, have a deductible, or limit the type of care you receive (such as limiting the frequency or duration of physical therapy or chiropractic care). Also, your health insurance company has the right to place a “lien” on your case (which requires that it be paid back when your case settles). The law allows such liens because if your health insurance pays your medical bills and the other side’s insurance company also pays your medical bills, then you would have been paid twice for the same loss.
If you do not have health insurance, you may qualify for some special programs that may temporarily cover your medical bills. For example, if you were injured by a person who was also committing a crime (a drunk driver, for example), you may be entitled to have some or all of your medical bills paid by the “criminal compensation fund”, which is funded by fines assessed against criminals to pay for the losses generally sustained by crime victims. Any money advanced to pay your medical bills will usually need to be paid back to the criminal compensation fund when your case settles so that the funds paid back can help pay for the losses suffered by other criminal victims. You may also look into a service such as Well States Healthcare (link is http://www.wshcgroup.com/).
In some cases there is no immediate source to pay your medical bills, except by your personal check, cash, or credit card. If this is the case, keep detailed receipts to prove what you have spent. These amounts will be included in your claim against the at-fault party.
How do I get the proper medical treatment?
Getting proper medical treatment is very important to your physical recovery. This means you need to get enough treatment to properly heal, while avoiding over-treating. In our experience a few chiropractors, a few physical therapists, and a few pain specialists give a bad name others of their professions by over-treating injuries for the main purpose of getting insurance company medical payments.
If you find that a medical professional is asking you to come back multiple times a week for month after month and you are not getting better, consult with your primary care physician and ask for other recommendations. Insurance companies properly balk at paying for excessive treatments that do nothing for the patient’s condition. If you over-treat you may be left alone to pay such bills. If you suspect you are being over-treated by an unscrupulous medical provider, stop and consider your options.
One of the ways to show the at-fault party’s insurance company that your claim’s stated injuries are valid is by quoting from your doctor’s medical records. Medical charts are written by doctors to document what your complaints are at each visit and what treatment was given. These records help prove your injuries and document how these injuries have impacted your life. Doctors are trained to recognize and diagnose problems associated with injuries. Their observations will carry far more weight with the insurance company and jury than your word alone. Because of this, it is very important that you clearly communicate all of your complaints to your doctor at every visit. Getting medical treatment from competent providers is essential for your recovery and will also establish your injury claim.
There are several risks you should be aware of when seeking medical care after an injury. First, beware of any medical provider who claims to specialize in accidents. Insurance companies are skeptical of such a doctor’s conclusions. If your primary care physician takes the time to really know you, she will be able, better than anyone else, to see the difference in your condition before and after your injury. A competent and caring primary care physician can help guide your care by referring you to trusted specialists. Also, make sure your doctor listens to you and treats your injuries. Some doctors hate all lawsuits and will treat you poorly because you are making a claim. Such a doctor will probably not come to court to testify and a doctor with such an attitude probably will not provide the treatment you need.
How much time do I have to make a claim (statute of limitations and deadlines)?
Each state puts specific time limits on how long you have to file any type of claim. These laws are called “statutes of limitations.” The length of time differs depending on what happened and who did it.
In Oregon, some of the statutes of limitations are found in chapter 12 of the Oregon Revised Statutes. But not all time limits are found there, and there are countless exceptions to general rules, so we must sometimes look elsewhere to determine how long you have to file suit.
Some cases have a much shorter time frame (such as when you are suing a state or local government, or when you are suing someone for serving alcohol to a visibly intoxicated person who later drives a car and hurts or kills someone). Because these limits can be as short as 180 days, getting legal advice quickly is essential to preserving your claim.
The time limit for most personal injury claims in Oregon is two years. (But there are many exceptions to this general rule.) If you have not settled your case, you must file a lawsuit within the applicable statute of limitations, or your claim will become time-barred and worthless. If this happens the other side does not have to pay for anything, no matter how wrongful their conduct. You must either have settled your case or filed a lawsuit before the statute of limitations expires.
Cases sometimes (but not always) have longer time frames, such as when the injured person is a minor, or the cause of harm is hidden. The rules for these exceptions are complex and you should not assume that any exception would apply to your case. (For example, not all cases involving minors have extended deadlines and not all hidden injury cases have extended deadlines.) As you can see, understanding deadlines is a complicated process and can get confusing quickly. If you even think you may be a coming up on a legal deadline, check with an attorney.
Filing a lawsuit does not mean your relationship with the insurance company has to become hostile. Insurance companies understand that you need to protect your rights by filing the lawsuit to meet the statute of limitations. Do not rely on an oral agreement with the insurance company that it will pay your claim after the statute of limitations expires. (You may think you have an agreement and the insurance company may not.) An oral agreement to extend the statute of limitations would probably not be enforced by a court. If you are approaching a statute of limitations, contact an attorney right away to help protect your interests.
Because correctly determining legal deadlines can be very complex, even for an attorney (it is the number one cause of legal malpractice in personal injury law), you should find out early on the specific deadlines in your case. Because deadlines are strictly enforced, missing a deadline by even one day will bar your claim.
What if the other driver is uninsured or underinsured?
Oregon law requires every driver to carry car insurance. Unfortunately some drivers ignore this law and drive without any insurance. When these drivers cause accidents they are likely to be judgment proof. By law your own insurance policy must include coverage for these Uninsured Motorists (UM). Your UM coverage will compensate you for your losses in the same way that the bad driver’s insurance would have done, if he had insurance. Your UM policy pays you instead of the person that hit you. You paid for this UM coverage when you purchased your insurance. Since you were not at fault in causing the accident, using UM coverage will not increase your insurance rates.
Sometimes collisions result in very severe losses that are more than the policy limits of the at fault driver’s insurance policy. This means the bad driver did not carry enough insurance to cover the damage done. In these instances the bad driver’s insurance company usually will offer to pay its limit (sometimes only after extended negotiations), but this policy limit will not fully compensate you for your losses. In such a case you may seek additional compensation under the Underinsured Motorist (UIM) provisions of your own automobile insurance policy. For such injuries you may collect both the at fault driver’s insurance policy and also part or all of the UIM benefits of your own automobile insurance policy. Such UIM benefits cover your losses that exceed the policy limits of the bad driver’s insurance policy (up to the limit of your own UIM policy).
Your UM and UIM policy limits are described in your auto insurance policy. If you intend to make a UIM claim, you must have your own insurance company’s written consent to settle for the bad driver’s insurance policy limits. If you fail to obtain this written consent, you will lose your right to access your UIM coverage. If you bring a copy of your own insurance policy to your free interview, we can answer your questions regarding UM and UIM benefits.
What is a policy limit, and why should I care?
The policy limit is the amount of insurance available to pay your loss. In most circumstances the other side’s insurance company is only required to pay losses up to its policy limits. Anything over the other side’s policy limits will have to be paid by another insurance policy, waived by the injured person, or collected from the defendant personally. Policy limits are generally only a problem in cases with severe injuries.
Also, an insurance policy only covers the losses specified in the policy. For example, the careless person’s house insurance probably will not cover car accidents. Conversely, if someone owns dangerous property, his house insurance will pay but his car insurance will not.
The available policy limit will vary according to the individual policy and the type of insurance. Oregon law requires many types of insurance. For example, every person who owns or drives a motor vehicle must have automobile insurance. Likewise, every attorney who practices in Oregon is required to have liability insurance. Nearly every hospital will require every doctor with hospital privileges to carry liability insurance. Nearly every mortgage company will require a homeowner to carry insurance. The list goes on. Other types of insurance include commercial policies covering businesses, renter’s insurance, boater’s insurance, and various other types of malpractice insurance. Because of the wide varieties of insurance available in Oregon, virtually every personal injury case that we handle will be covered by at least one insurance policy. This means it is probable that the person who actually hurt you will not have to pay anything because their insurance will cover it. When more than one insurance policy is available, certain rules govern which policy pays first. An attorney knowledgeable in personal injury law can sort all this out.
Aren’t most of these personal injury cases just attempts to get free money from insurance companies?
The answer is a resounding no. Big surprise, right? Here are how these cases usually happen: someone carelessly hurts someone else. The injured person wants her medical bills and lost wages paid, and also wants to be fairly compensated for her loss of activities and for her pain. She is only seeking to balance the scales of justice by asking for the amount of money that will be equal to what she has lost. The other side’s insurance company is a for-profit corporation, which insured the at-fault person against the risk of harming others. But once the harm occurs, the for-profit insurance company wants to pay out as little as possible and sometimes nothing at all. When that happens, the injured person has two choices: suffer his losses and just live with the injustice, or he must begin legal action.
Perhaps you have heard of “frivolous lawsuits.” But insurance companies often engage in “frivolous defenses” – denying liability when it is reasonably clear, and denying damages that have obviously been suffered. Insurance company greed consists of keeping money that should be paid and making the injured person spend time and money to file a lawsuit.
When that lawsuit has to be filed, if the case doesn’t settle, a jury will hear the evidence. Juries determine case values. There is nothing shameful about requiring an insurance company to fairly and justly pay for injury losses. In fact, holding people accountable is good for society because it improves public safety and allows injured persons to retain their dignity by helping them get back to where they would have been had they not been injured. It also reduces the burden on the taxpayers, as people who have been taken care of by the insurance company of the wrongdoer are less likely to have to receive public benefits.
So how does a jury determine the value of non-economic damages? Think about the things you love most in life, and think about how much money it would take for someone to buy that part of your life. What if. Think about what it would be like to struggle to complete a simple hike instead of taking overnight backpacking trips; to be unable to read for more than a few minutes instead of savoring a good book in one sitting; to be unable to use a computer for more than a few minutes because of neck pain; to be unable to ski or hunt or fish or play golf or tennis, as you once did. Think of how devastating it is for a child (and her parents) to grow old with permanent life-altering injuries. How much is enough money if these things were taken from you?
The appropriate amount of damages is how much you would require someone to pay to do that to you. That’s what juries should fix as the amount for non-economic damages.
So why do cases end up in trial? Because insurance companies want a discount after the harm has been done. Why? They want to protect their profits. That’s not fair to injury victims who have lost a significant part of life and now have to struggle to prove how much that loss is worth. Of course insurance companies should make sure claims are legitimate and they should carefully evaluate each case. But insurance companies sometimes show corporate greed by unjustly retaining money that should have been paid out to injured people. That is why personal injury lawsuits are filed and why attorneys are necessary—they keep insurance companies honest by bringing them to account when they refuse to justly pay for the harms suffered by injury victims.
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If you have been injured and you are not sure what steps to take next, call us. We can help.