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James O'Rourke - Criminal defense lawyer Portland Oregon


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Law Offices of James F. O'Rourke Jr. and Associates

503-221-1425 - Portland Office

James F. O'Rourke Jr. and Associates duii defense attorneys

Why does my insurance company have to pay my medical bills when I am in an accident that is the other person’s fault?

Question: Why does my insurance company have to pay my medical bills when I am in an accident that is the other person’s fault?

Answer: Because it is required by law. Oregon law (O.R.S. 742.520) requires that every automobile policy carry a minimum of $15,000 of Personal Injury Protection (PIP) coverage.

PIP Coverage

PIP coverage is a “no-fault” coverage that is required by law in the State of Oregon. If you are injured in a car accident, the insurance company that covers the vehicle in which you were traveling will pay your medical bills regardless of whose fault the accident was. The minimum amount of PIP coverage required by law in Oregon is $15,000. Given the high cost of health care, many drivers opt for higher PIP limits to protect themselves from having to pay substantial medical expenses out of pocket.

The purpose of requiring PIP coverage is to ensure that the injured party’s medical bills get paid as they are incurred instead of waiting until settlement with the third party, which could take months or years. Without PIP coverage, the potential exists that the injured party will be financially unable to pay his or her accident related medical bills. This could result in bills being sent to collections and have an adverse effect on the injured party’s credit rating. PIP coverage provides the insured with the peace of mind that his or her medical bills will be paid.

The way PIP coverage works is to provide the insured with medical benefits for up to one year or the dollar limit of the policy, whichever occurs first. To qualify for payment under PIP coverage, the medical expense must be “reasonable, necessary, and related” to the accident. Your insurance company will recover the benefits paid from the at fault party after your case is settled.

PIP coverage also provides a wage loss benefit. If you are disabled from work as a result of the accident for a period of at least 14 days, your insurance carrier will pay you wage loss benefits totaling 70% of your gross monthly wages or $3,000, whichever is smaller, for up to one year.

If the insurance company suspects that your medical treatment is no longer “reasonable, necessary and related” to the accident, they have the right to request that you attend an Independent Medical Examination (IME). Depending upon the outcome of the IME, or if you refuse to attend, the insurance company can deny payment under your PIP coverage.

The laws and regulations governing auto insurance are complicated. This is why we recommend that if you are injured in an accident, you call us right away. As personal injury lawyers in Tigard and Tualatin, James F. O’Rourke Jr. & Associates have vast experience helping our clients ensure that their medical bills are paid under their PIP coverage. If you are injured in an automobile accident, call James F. O’Rourke Jr. & Associates.