Brookings, OR asked in Car Accidents and Insurance Bad Faith for Oregon

Q: Why is the insurance company forcing me to use my PIP to reimburse me for my lost wages for a non-at fault accident?

I was in an accident were liability was determined to be completely the other drivers fault. Both of us have the same insurance carrier (Progressive). The insurance company forced me to use my own PIP to pay my medical bills. I would have rather not used my own policy (PIP) and filed a third party claim against the other drivers policy. The insurance company seems to be lying to me and is forcing me to claim my lost wages through my own PIP at 70% of my normal wages. I have informed the insurance company the other drivers policy would have to pay me the additional 30% to cover all of my lost wages. Why can't the other drivers policy just pay for 100% of my lost wages without having to use my PIP????? I feel Progressive is manipulating me and will raise my rates for using the PIP on my policy!

6 Lawyer Answers
Mr. Michael O. Stevens
Mr. Michael O. Stevens
Answered
  • Personal Injury Lawyer
  • Hillsboro, OR
  • Licensed in Oregon

A: Because that is how it works until you settle with the insurer for the at-fault party. That insurer has no obligation to pay you anything until you settle or take them to court. This is why PIP exists, so you can get medical care and lost income while you wait to be able to settle with the other driver's insurance company.

Tim Akpinar and Joanne Reisman agree with this answer

1 user found this answer helpful

Tim Akpinar
Tim Akpinar
Answered
  • Personal Injury Lawyer
  • Little Neck, NY

A: Progressive is not likely to be doing that to manipulate you; they are doing it that way because that's the operation of law for PIP benefits. It's actually better than the alternative. In your case, liability is a no-brainer. But for accidents where liability is bitterly contested and the parties find themselves in protracted litigation, these types of benefits can remain suspended for years. Doing things this way also keeps court dockets clear of smaller claims. Good luck

Tim Akpinar

1 user found this answer helpful

Vincent J. Bernabei
Vincent J. Bernabei
Answered
  • Personal Injury Lawyer
  • Beaverton, OR
  • Licensed in Oregon

A: Mr. Stevens is correct. The insurance company for the at-fault driver ordinarily will refuse to pay anything for your personal injury claim unless that claim is completely resolved. There won't be any partial payments. The 70% of income calculation is a rough estimate of after-tax income. You can recover all of your lost income at the time you completely settle your claim. When you settle your claim, you may be required to reimburse your insurance company for the PIP benefits it paid before you settled your claim against the at-fault driver and his/her insurance company. You should contact an attorney for a free initial consultation to learn more.

Joanne Reisman
Joanne Reisman
Answered
  • Personal Injury Lawyer
  • Portland, OR
  • Licensed in Oregon

A: First of all, why in the world don't you get an Attorney to help you with your case. You ALWAYS get more money overall when you hire an Attorney so after paying a percentage to your Attorney you will at least get as much as you are going to get trying to do this yourself.

Your questions here tell me that you don't know what you are doing. Using PIP is exactly what you want to do. You get the money up front, no questions asked and you maintain your right to sue the other driver when you are good and ready to do this. If you had instead chosen to sue the other driver up front, or settle your claim, they would have required you to sign a waiver that would forever cut off your claim. This is an extremely bad idea because until you are done treating and all better you have no idea what your claim is.

I regularly counsel my clients to use PIP. That shifts this expense to the insurance company which will then fight with the at fault driver's insurance company and between the both of them, they will figure out how much the at fault driver has to reimburse your insurance company. You don't have to worry about it. Your bills are paid and you already have at least 70% of your wages in your pocket, which you don't have to pay income tax on by the way, so it is more like 100%.

You have PIP coverage for up to two years or until you use up the maximum benefit. So all you have to worry about is getting better. That is the entire purpose of PIP. (Now your insurance company could at some point decide to try to cut off PIP if they think you are over treating so having an Attorney to help you figure out what to do at this point is invaluable. When your insurance company tries to do this they will ask you to get an IME, independent medical exam, which is usually with some hack they pay to do a medical exam and justify the insurance company in stopping your PIP payments. Big scam and you absolutely need an Attorney to guide you if this happens.)

Anyway, relax and take advantage of your PIP coverage to the extent you need treatment and time to recover. You have up until two years for the date of the accident to settle your claim or file a lawsuit. There are "tricks" that an experienced PI Attorney will know that will leverage your claim and get you a maximum recovery, and using PIP is crucial to making this possible. Call around and hire a good PI Attorney to take over your claim!

Jennie Lynn Clark
Jennie Lynn Clark
Answered
  • Personal Injury Lawyer
  • Portland, OR
  • Licensed in Oregon

A: To Whom It May Concern:

PIP is no-fault. It is a standard operating procedure for your PIP to cover regardless of fault. The policy reason behind this is that people should be able to obtain treatment without having to argue about the fault of the involved drivers, as liability can get messy, especially when one party could be only partially at fault.

At the end of the case, some companies have intercompany arbitration to resolve how the insurance companies will reimburse each other. Other insurance companies expect reimbursement for what they have paid out of the final settlement. It is the election of the insurance company how they will be reimbursed. At the end of your case, you can request an additional 30% for your lost wages. Normally, these are the sorts of things a law firm handles by getting the insurance company's position in reimbursement in writing. Assuming you are not at fault, in the end, you are entitled to your additional lost wages and non-economic damages and possibly other types of damages. Our firm normally sends out a demand package prior to the statute of limitations, including a detailed demand letter with supporting documentation. If the case is not resolved via negotiation, then a lawsuit is filed and the negotiations continue. The nice thing about having an Oregon attorney is that we are all required to PLF insurance, meaning that if you have representation and your attorney misses an important deadline, like the statute of limitations, then there is insurance coverage.

1 user found this answer helpful

Virgil Royer
Virgil Royer
PREMIUM
Answered
  • Personal Injury Lawyer
  • Salem, OR
  • Licensed in Oregon

A: PIP is a great tool to ensure that everyone involved in an accident involving an insured motor vehicle has medical coverage and some funds for lost wages rather than having to wait for a year or more to get paid by the at-fault party. Lost wages don't start until after the 14th day of time off, so you'll attorney will have to recover the those first 2 weeks of hours for you in your claim; as well, you only recover 70% of the amount. So, you'll attorney will have to recover the additional 30% at the time of your claim. As far as medical treatment, PIP pays for treatment you received from the date of loss for one year. You can get the bills paid after the one year, so long as it is for treatment that was received within the one year from the date of loss. Also, PIP becomes your primary insurance for the accident. It is preferred. For example, if you are on the Oregon Health Plan (OHP) you will not likely receive certain types of healthcare, such as chiropractic, massage, Acupuncture, and/or physical therapy. PIP will generally cover any treatment related to injuries you experienced from the car accident. If you have other insurance, and/or work disability, you may in--some cases--receive that as well, but most insurance policies have a clause requiring reimbursement if you receive compensation for benefits that they paid to you. An experienced attorney will guide you and protect your best interests. You have an excellent question.

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