#3 Is there a difference in how Personal Injury Protection (PIP) works if my patient is injured as a pedestrian?
QUESTION: Is there a difference in how Personal Injury Protection (PIP) works if my patient is injured as a pedestrian?
ANSWER: If your patient was hit by a car and injured as a pedestrian, if they had their own auto insurance at the time of the accident, they will file a PIP claim with their insurance company. If they didn’t or their PIP benefits are exhausted, and they were living with a family member at the time of the accident, they can file a claim on their family member’s policy. If neither of those are options, then they use their own health insurance. If none of those are options — or benefits are no longer available, they can file a claim against the at-fault driver’s PIP policy.
Is there a difference in how Personal Injury Protection, PIP works if my patient is injured as a pedestrian?
There are a couple of key differences when your patient is injured as a pedestrian.
If your patient is crossing the street and is hit by a car making a right-hand turn, the first PIP policy you look to make a claim with is your patient’s own automobile insurance policy. If your patient owned a car and had auto insurance at the time of their accident, they will actually file a claim with their car insurance company. If they didn’t have their own auto insurance at the time of the accident — or if their PIP benefits become exhausted, there are still PIP policies your patient may be able to use.
The Oregon PIP statute states that if your patient was living with a family member at the time of the accident who has their own car insurance — a parent, aunt, uncle, sibling, or cousin, your patient can file a claim on that PIP policy.
If neither of those scenarios are options, Oregon statute requires that your patient use their health insurance to cover their medical expenses from the accident.
Lastly, and only when your patient is a pedestrian, can they make a claim on the driver who caused the accident’s PIP policy.
Filing a claim against the driver’s PIP coverage will require proof that your patient:
- Did not have access to other PIP policies
- That the PIP benefits were exhausted for PIP policies they did have access to
- That your patient does not have health insurance
- Your patient’s health insurance is not covering certain types of treatment
Only when documentation is submitted, will your patient’s claim be considered by the at-fault driver’s PIP carrier to reimburse your patient for deductibles, co-pays, and treatment not covered by their PIP policies or health insurance.
We’re here to be a bridge of support for you and your patients.
We have developed a robust library of information for your patients who have been injured in an accident, which can be found in the INJURED? START HERE portal on our website.
There are 40 topic-focused articles, with accompanying videos, organized into the four categories that include the personal injury claim-related questions we’re asked most often, which include:
- Top 10 Personal Injury Claim Mistakes to Avoid
- What You Need to Know About Your Claim
- How Are My Medical Bills & Wage Loss Paid
- How to Prepare for Your Independent Medical Exam
Each article provides advice and guidelines to help your patients navigate each phase of the personal injury claims process. Whether we represent your patient or not, we are passionate about them knowing how to protect their rights, get the medical care they need, and avoid the mistakes that can harm their personal injury claim.
Each article provides advice and guidelines to help your patients navigate each phase of the personal injury claims process. Whether we represent your patient or not, we are passionate about them knowing how to protect their rights, get the medical care they need, and avoid the mistakes that can harm their personal injury claim.
Additionally, if it would be helpful to have the information we feature on our website available in your office to pass along to your patients, we’ve developed brochures for each of the four article series -- in both English and Spanish that we’re happy to send to your office. Please complete the form below and we’ll get them out to you promptly.
