A note on where this comes from: I spent over 20 years defending motor vehicle accident cases for insurance companies. I know how PIP adjusters are trained to evaluate treatment, challenge necessity, and manage costs, because I was on that side of the table. I am happy to help you make sure you are not denied the benefits you are owed.
Oregon requires every auto insurance policy to include Personal Injury Protection (PIP) coverage. PIP pays your medical expenses and a portion of your lost wages after an accident, regardless of who was at fault. Understanding exactly what PIP covers, and what insurers do to limit it, is one of the most important things an accident victim can know.
What PIP Covers Under Oregon Law
Under ORS 742.518, Oregon’s minimum PIP benefit is $15,000 per person per accident. Your policy may carry higher limits. Check your declarations page. The minimum coverage includes:
- Emergency room visits, hospitalization, and surgery
- Ambulance and medical transport costs
- Physical therapy and rehabilitation
- Lost wages, up to 70% of your gross weekly wages, capped at $3,000 per month
- Essential services: household tasks you cannot perform due to your injury
Your insurance company cannot deny PIP because the other driver was at fault. That is not how PIP works. The coverage exists precisely because fault takes time to determine, and you cannot wait months for treatment.
What Insurers Do to Limit PIP
While your insurer cannot deny PIP based on fault, they have other tools. The most common is the Independent Medical Examination, a referral to a physician of their choosing to evaluate whether your ongoing treatment is still “medically necessary.”
These examinations are not as independent as the name implies. The physicians who conduct them are paid by insurance companies and conduct them regularly. When I was on the defense side, I worked alongside those evaluators. Their job is to find a basis to cut off treatment, not to provide a second opinion on your care.
If your insurer requests an IME, do not ignore it. Failing to attend can be used as grounds to suspend your PIP benefits. Talk to an attorney before you go.
The Claim Submission Deadline
PIP has a claim submission deadline. Oregon law requires you to notify your insurer of an accident as soon as reasonably possible. Delays in notification give the insurer a basis to question coverage and, in some cases, to reduce or deny your PIP benefits.
Report the accident to your own insurance company promptly, even if the other driver was clearly at fault. Notifying your insurer is not an admission of fault. It is a necessary step to preserve your PIP rights.
PIP and Your At-Fault Claim: Two Separate Tracks
PIP is just the first layer of recovery. VWSH helps clients navigate both tracks at the same time: your PIP claim with your own insurer, and your claim against the at-fault driver’s liability insurance. They run on different timelines and have different leverage points.
Managing both effectively requires someone who understands how each insurer is approaching the case. That is exactly what a defense background teaches you to see.
Are your PIP benefits being challenged or denied?
Free consultation. No obligation. We will tell you what your PIP covers, whether your insurer is acting in good faith, and what your full recovery options are. No fee unless we win.
Eric Waxler
Attorney · Vames Wang Sosa Hood
Eric Waxler spent over 20 years defending insurance companies in motor vehicle accident cases before joining Vames Wang Sosa Hood. He now uses that inside knowledge to protect injured Oregonians from the tactics he once used professionally.
This article is for informational purposes only and does not constitute legal advice. Oregon law is subject to change. Statutory references are current as of the date of publication. Contact Vames Wang Sosa Hood for legal counsel specific to your situation.