Medical Bills and Wage Loss

How Are Medical Bills and Wage Loss Paid After a Car Accident?

Medical treatment is not inexpensive. Even if you have health insurance, between deductibles and co-pays, medical care can be financially out of reach for many.

One of the biggest mistakes is not getting the medical treatment you need. Because not everyone knows about PIP, they may not get the medical treatment they need.

The good news is that PIP will pay for both the medical treatment you need, and may pay your wage loss — if your provider takes you off work.

1. How are my medical bills paid and what is Personal Injury Protection (PIP)?

A. What is PIP?

If you are injured in a car accident, you have the right to receive medical care, and also to receive time loss or other benefits if you can’t work or manage your household tasks. These benefits are paid by the PIP part of the auto insurance company for the car you were in when the accident happened. 

PIP is a part of every private passenger policy sold in the state of Oregon. Even if you only have liability coverage, your auto policy has PIP in it. It’s required by law.

B. What are the basic PIP benefits?

Following are the minimum benefits required under Oregon law. You can purchase PIP coverage with greater benefits. Ask your insurance agent about the extent of your coverage.

  1. All medical expenses incurred for two years after the date of injury, up to a maximum of $15,000. The medical bills must be reasonable in amount and related to your injury from the accident.
  2. Wage loss benefits of $3,000 a month or 70% of the average monthly income, whichever is less. You must be “usually engaged in paid work.” You must be off work for at least 14 consecutive days.
  3. If you do not “usually” work, you can receive up to $30 per day for “essential services.” This benefit applies if your  medical provider states in writing that you require assistance with household work. This, like wage loss benefits, can continue for an aggregate of 52 weeks.
  4. If you are a parent of a minor and you are hospitalized for at least 24 hours, child care benefits can be claimed up to $15 a day, with a maximum of $450.
  5. Reasonable and necessary funeral expenses incurred as a result of the accident, within one year of the accident. The minimum coverage required by law is $5000.

C. My doctor says I should not work. How will I pay my bills?

PIP benefits include compensation for income you lose if your injuries prevent you from working. This applies whether you are an employee or self-employed.

The minimum PIP benefit for lost income is 70 percent of your gross wages or $3,000 per month, whichever is less, for 52 total weeks. 

You must be off work for at least 14 days before you are entitled to PIP wage loss benefits, but your benefits will then be effective from day one.  The insurance company will want your employer to verify your lost income and need an off work note from your medical provider. 

D. How will my medical bills be paid?

Basically, all automobile insurance policies provide personal injury protection (PIP) benefits. PIP pays all of your medical bills from the auto collision. You are entitled to PIP benefits regardless of who was at fault in the accident.

The insurance company will pay for the medical care necessary to treat your injuries. Most PIP policies limit your medical benefits to two years after your injury and a total of $15,000. So all of your medical bills up to $15,000 and within two years after the collision are covered.

If you were in a car that did not have insurance, or if the PIP has been exhausted, don’t lose hope. There may be other car insurance that will pay your medical bills.

2. How is my wage loss paid if I've been injured in a car accident?

As outlined above, you are entitled to wage loss benefits through PIP up to $3,000 a month or 70% of the average monthly income, whichever is less. You must be off work for at least 14 consecutive days. A medical provider must have written an off work note.

It is generally easier to establish your wage loss if you are an employee. If you are self employed, you are still entitled to wage loss benefits. There is typically substantially more documentation to prove your average monthly income.

3. Can I see the medical providers of my choice following a car accident?

Absolutely. We will work closely with the medical providers you see for your injuries. If they have any questions or concerns, we are more than happy to answer them and provide any needed advice.

We work with medical doctors, chiropractors, naturopaths, acupuncturists, massage therapists and physical therapists.

The better the communication with your providers, the better your recovery and claim will go.

4. How are my medical bills paid if I’m hit by a car while walking or riding a bicycle?

If your injury involves a car, PIP will pay for your medical treatment. The following are few examples of when PIP will apply:

  • You are a pedestrian crossing the street and you are hit by as car
  • You are a bicyclist traveling on a street, when a car turns in front of you and hits you.
  • You are jogging on the side of road and you are hit by a car
  • You are changing a flat tire on the shoulder of a road and you are hit by a passing car
  • You are changing the tire on your car, when the jack breaks and your car drops on your foot.

Which PIP pays for your medical treatment is different than if you were injured in a car. As a pedestrian here is a list of who pays for your medical treatment- in the order that is required by statute:

  • Your own auto insurance
  • The auto insurance of a family member you are living with when injured
  • Your health insurance
  • The PIP for the car that hit you

5. What happens if my PIP runs out, and I still need treatment?

There often can be multiple PIP policies that will pay for your medical treatment. So, even if the $15,000 of PIP medical bill benefits are used up, don’t give up hope- there are other PIP policies that may be available for you.

Here is an example of being able to use three different PIPs. You are a passenger in a friend’s car that is rear-ended. The PIP that covers the car you are in is primary. If all of the medical benefits for that PIP have been used up, you are able to apply for PIP on your own auto insurance policy- even though it was not involved in the accident! At strange as it sounds, if those medical benefits are used up, you can apply to the PIP policy on a family member that you were living with at the time of the accident!

Talk to a lawyer before you stop getting the medical treatment you need, even if the PIP medical benefits for the car you were in have been used up.

6. What should I NOT do if the insurance company is threatening to stop paying for my medical treatment?

Anytime PIP is threatening to not pay for your medical treatment from the accident, DO NOT STOP TREATING!! The vast majority of the time we are successful in helping you get the medical treatment you need and force PIP to pay for your medical treatment.

Insurance companies count on you stopping your medical treatment and not talking to a lawyer. Don’t let the insurance company stop you from getting the treatment you need to have a full and speedy recovery. Your health is more important than the insurance company trying to save money by not paying.

7. What should I do if my injuries return after I’ve completed treatment?

It is not unusual for injuries to occasionally worsen after you have stopped treatment. What is most important is that you see your providers as soon as it happens. The longer you wait, the more likely the insurance company will say that something else must have happened to cause your additional treatment.

Call your provider, let them know what’s happening and follow their advice.

8. Will PIP cover my lost wages because of medical appointments?

Unfortunately, PIP only covers wage loss if you have been taken off of work for 14 calendar days by your medical provider. If you have to take time off for your treatment, you can make a claim for it through the at fault insurance company when your done treating. They will not pay any wage loss until settlement time.

Be sure that your employer knows that the time you are taking off is for medical treatment related to the accident. You will need documentation of your lost time. If your employer doesn’t have a record of why you were off work, they will not be able provide the information you need to get your wage loss, at settlement.

9. The PIP carrier keeps calling me and asking about my treatment, should I talk to them?

Under Oregon law, you are required to cooperate with PIP. This means you have to sign a medical authorization, give them a recorded statement and answer questions throughout your treatment.

It’s important to know that when the adjuster calls, they are not asking you questions that is about making sure you are really getting better. Their job is to protect the insurance company. They are looking for any reason to justify stopping paying for your medical treatment.

When you talk with the PIP adjuster, be careful about what you say. They can easily use what you say against you. If you have a lawyer, you will not have to talk with any insurance company.

10. If I’m using the PIP from my insurance company, they will treat me better, right?

Unfortunately, just because you have been paying premiums to your insurance company for years, they are not going to treat you any better. The adjuster’s job is to manage the claim and minimize the amount of money their employer, the insurance company, has to pay out.

Most adjusters are very nice to talk with. Do not confuse their kindness by assuming that their job is to look out for you. Like any good employee, they have a job to do and it’s to protect their employer.

We’ll help you determine whether you have a case and if you need an attorney. It doesn’t make sense to hire a lawyer if you don’t need one.

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