Personal Injury Protection or PIP is a required feature of auto insurance in Oregon. When you are injured in a motor vehicle accident your insurance will pay for all reasonable and necessary medical treatment related to the accident for one year, up to your coverage limit. Everyone has at least $15,000 of PIP coverage under the law, and this coverage does not depend on fault. That means even if you caused the accident you are still entitled to medical treatment under your PIP policy.
Most people never have a problem with their PIP insurance, they get treatment and the insurance company pays for it. However, lately insurance companies have been using many tactics to attempt to cut off injured peoples benefits even before they reach the one year or $15,000 limit. Sometimes insurance companies simply deny coverage as unnecessary or unrelated to the accident. More often you will receive a letter from your insurance company requesting that you attend something called an “Independent Medical Exam” or IME.
Don’t be fooled by the name, these exams are not independent and they are barely even medical exams. Insurance companies have doctors who will review the medical records from your treatment, perform a brief interview, and a cursory physical exam. The doctor will then prepare a report, which 99 times out of 100 will say that you have already received enough treatment, your injuries have all fully resolved, and that you do not require any additional medical care. Your insurance company will use that IME report to deny any additional payments for medical treatment.
What Can You Do?
The first thing you should do is listen to your doctor or primary medical provider. If your doctor doesn’t think you are back to 100% then you need to keep treating your injuries. You only get one body so you need to take care of it. The biggest problem that people have is figuring out how to pay for additional treatment. Often people will have personal health insurance which can kick in and pay for doctor’s visits, MRIs, x-rays, and physical therapy. Sometimes your primary treatment clinic will be sympathetic to your plight and defer billing pending resolution of your injury claim. One way or another you should try to continue getting helpful treatment.
The next step is to figure out if the denial of your PIP benefits was unreasonable. This is where your primary care doctor is extremely helpful, they can review the IME report and refute the findings. If it turns out that the insurance company unreasonably denied your benefits then you may have a separate claim against them. Under the laws in Oregon you have to wait six months before filing a complaint against your PIP carrier and the law also provides for attorney fees which means that if it comes to a lawsuit often the insurance company has to pay for your lawyer.
If you have been asked to submit to an IME after a motor vehicle injury or if your PIP benefits have already been denied, call or email us today for a free consultation.