What Happens When My Personal Injury Protection (PIP) Runs Out?

 

A common question we get at Philbrook Law is “what happens when my PIP runs out?”. There’s not necessarily an easy cut-and-dry answer to this question, but there are some common scenarios.

• Who pays my medical bills after I’m injured in an accident?
• What is personal injury protection (PIP)? What does it pay for?
• What happens if my PIP limits are exhausted? Will my insurance go up?
• What happens when no more insurance money is available?
• When is the at-fault party responsible to pay my bills?

Who pays my medical bills after I’m injured in an accident?

For many who have not previously been involved in an accident, like a car crash or a slip and fall, it’s a surprise to find out that the at-fault party’s insurance will not pay your medical bills as they accrue.  The law requires those who are at fault for an accident to pay all damages which flow from, or are proximately caused, by your personal injury. This includes property damage, out of pocket costs, medical bills, loss of vehicle use, wage loss, pain and suffering, etc.  The property damage claim can be handled independently of bodily injury and wage loss, and therefore is often resolved within a month.  All other claims for damages would be handled together, and the claim settlement is global in nature.

What is personal injury protection (PIP)? What does it pay for?

PIP is Personal Injury Protection (PIP). PIP is ALWAYS RECOMMENDED FOR EVERYONE.  The function of PIP is for your insurance company to step into the shoes of the at-fault party, and pay your medical bill(s) right away.  PIP insurance has no deductible, and can be used with any medical provider.  This gives you the power to control your healthcare.  PIP insurance is mandatory in the State of Oregon, with a limit of at least $15,000.  In Washington, PIP can be waived by the customer. Even though the price of PIP is fairly low (generally around $6 per month), many people waive it.

Waiving PIP always benefits the insurance company.  It’s not a money maker for the industry, and I’ve seen some deceptive practices to encourage waivers.  One thing to look out for is the online application process that some insurance companies use.  Often times the PIP waiver box is pre-checked on the form.  If you do carry PIP, your bills will be paid in a timely manner, with no out-of-pocket expenses to you.  PIP will function as your primary insurance for all health care related to the collision.  PIP will also cover a percentage of your wage loss for up to a year (this does not apply against your limits).

What happens if my PIP limits are exhausted? Will my insurance go up?

Most PIP policies have $10,000, $15,000 or $35,000 limits.  In serious injury cases, those limits can be exhausted quickly (if there is a hospital stay, surgery, or detailed testing), or over time (if injuries do not resolve as expected).  I recommend that you understand your PIP limits, and pay attention to your total bills.  A common scenario is for doctors, chiropractors, massage therapists, etc., to administer conservative treatment while billing PIP to the max; and if the injury does not resolve, you get a referral for an MRI or specialist, with no more insurance money to pay the bill.

Even if you do have a good understanding of your bills and limits, PIP may be exhausted.  If this is the case, your health insurance would be the next resource.  Health insurance is more restrictive than PIP, and often times you will have some out of pocket expenses, but it’s a valuable tool to receive the proper care.

What happens when no more insurance money is available?

If PIP is waived or exhausted and no additional insurance exists, you will need to find treatment providers who are willing to defer payment of the bill, or accept a payment plan.  One of the many benefits of working with an experienced and well respected personal injury attorney is we work with all levels of doctors who trust our work and are willing to accept a promise to pay from the proceeds of a settlement.  This usually only applies to smaller offices, where the treatment provider is in control of daily operation.  The facts of the claim need also be right to guarantee repayment.

When is the at-fault party responsible to pay my bills?

Eventually the at-fault person must pay all damages which flow from the accident.  This takes place when the parties agree upon fault, the reasonableness of all medical bills, and the value of your pain and disruption of life.  If an agreement is reached on all aspects of the claim, a settlement agreement and release is prepared which forever bars either party from seeking future money.  At that point in time, the PIP provider is also reimbursed for the medical bills they paid.

How does PIP work in Oregon?

Personal Injury Protection, or PIP, is insurance included in most auto policies in Oregon. After a car crash, PIP helps pay for certain expenses, no matter who caused the accident.

PIP Limits in Oregon

By law, Oregon drivers must have at least $15,000 PIP coverage. This amount covers each person injured in a crash and is available for certain expenses you incur within two years of the accident. It’s often possible to purchase higher limits if you want stronger protection.

Breakdown of what PIP covers

Here’s an overview of what PIP covers after an accident in Oregon:

Medical bills for accident-related treatment

PIP pays for necessary costs like doctor visits, ambulance rides, hospital stays, surgery, dental care, and prosthetic devices if prescribed. The minimum required coverage pays for these services until it’s used up or two years have passed.

Partial wage replacement

If you’re unable to work due to crash injuries, PIP can help with loss of income. If crash‑related disability continues for at least 14 days, PIP pays 70% of your loss of income from work (including wages, tips, commissions, and self‑employment profits). The cap is $3,000 per month, with a maximum aggregate of 52 weeks of wage‑loss benefits during your crash‑related disability.

Essential services

Sometimes, a person hurt in a car crash doesn’t lose regular job income because they work at home or do not have a paying job outside the home. However, injuries might stop them from handling necessary household duties, such as cleaning, cooking, or shopping.

Oregon’s PIP law recognizes this. When an injured person is disabled for at least 14 days after the wreck, PIP can pay for someone to help with daily living tasks. This could include things like basic housework or needed errands. Someone you already live with, or a relative, can’t be paid through this program. The policy pays up to $30 per day, for a total of up to 52 weeks if necessary.

Child care assistance

If the injured person is a parent of a minor child and is hospitalized at least 24 hours, PIP pays $25/day for child care (up to $750), starting after the initial 24 hours, while the parent remains unable to work or perform essential services.

Funeral expenses

If someone is hurt in an accident and passes away, their family can be reimbursed for funeral expenses that are reasonable and necessary, up to $5,000, as long as those costs are paid within one year after the injury happened.

Understanding how your PIP benefits work can relieve some of the financial stress that follows a crash and let you focus on your recovery.

Can you still file a lawsuit against the at-fault party if you claim PIP coverage?

Using your PIP does not stop you from going after the person responsible for hurting you. When another driver (or other party) is at-fault, you can ask their insurance or argue in court that they owe you for harm PIP does not cover, such as:

• Any pain and suffering you go through as a result of the accident
• Medical care you’ll need down the road that wasn’t covered by PIP
• All of the wages you lose if you can’t work for days, weeks, months, or even years
• The money you’d have made in the future, especially if you can’t return to your old job

Basically, any losses and damages you experience because of an accident can be recovered through a lawsuit. This is good news because the PIP benefits can be helpful, but are quite limited.

No double recovery

You’re not allowed to “double-dip,” meaning you can’t be paid twice for the same bills. If your case against the at-fault driver gets you a settlement (or verdict) for your medical costs, but PIP already paid for those, your insurer’s legal right kicks in.

For example, let’s say you needed surgery after an accident, and your PIP policy paid $10,000 for the hospital and doctor bills. Later, you file a lawsuit against the other driver and recover money to cover those same medical expenses. The insurance company that paid your PIP has the right to get back that $10,000 from your settlement. However, Oregon permits a PIP insurer to assert a lien and seek reimbursement only after you are fully compensated for your injuries, and any reimbursement must come solely from amounts exceeding full compensation, with the lien reduced by a proportionate share of your litigation costs and attorney fees.

The importance of working with a personal injury lawyer after an accident

Even if you qualify for PIP benefits after an accident, having a personal injury lawyer on your side can make a real difference. State laws are confusing, insurance companies can be tough to deal with, and you might miss out on money you’re owed if you don’t have someone looking out for you. Here’s how they can assist:

Making sure you get full compensation

After an accident, medical bills add up fast. PIP will cover some of these expenses quickly, but you might need long-term care or experience reduced earning capacity that goes on for years. A lawyer can fight to collect all damages you’re entitled to through PIP as well as a personal injury lawsuit when it makes sense.

Handling insurance companies

Dealing with insurance adjusters means confronting people trained to pay out as little as possible. You might get pressured into accepting a low offer early on. If you have a lawyer, it levels the playing field and makes it less likely that you’re going to get taken advantage of.

Cutting down stress during recovery

Healing from an accident is stressful, especially when you add in piles of paperwork, intimidating phone calls from the insurer, and stacks of medical bills demanding attention. With a lawyer handling the day-to-day details, you have an advocate dealing with these problems for you so you can focus on getting better and rebuilding your life.

No matter how major or minor your accident seems, having a lawyer focused on your personal injury case protects you and your family from unexpected trouble and costs down the line. The legal team at Philbrook Law, Accident and Injury Lawyers, supports clients every step of the way. Contact us today to schedule a free consultation and get the support you deserve.