Medical Bills After a Motor Vehicle Accident – What to do when your Insurance Company Refuses to Pay

Under Oregon law your own auto insurance carrier will usually pay your post-accident medical expenses under Personal Injury Protection, or “PIP.” If the at-fault driver has insurance, that driver’s carrier will reimburse your insurance company at the end of the case.

Unfortunately, we too often see cases where our client is denied medical benefits for personal injury by their own insurance company. Usually, the PIP carrier will request that the insured attend an “IME.” Although this is often referred to as an independent medical examination, it would be more accurate to describe it as an insurance medical examination. The examining doctor is hired by the insurance company with the intention that the doctor will provide a professional opinion to back up the carrier’s intended denial of benefits.

We always recommend that our clients follow through with the requested examination. Failure to do so would allow the insurance carrier to deny benefits based on non-cooperation.

In most cases, the insurance doctor gives the carrier the expected excuse for a denial. Either the patient “should be better by now,” or the ongoing symptoms and treatment “were not caused by the motor vehicle accident.”

Fortunately, Oregon law gives us two powerful tools to challenge these PIP denials. One approach to take is to immediately demand arbitration under the policy once the denial notice is received. This process leads to a hearing before an arbitrator (or a panel of three arbitrators). Each side appears through their attorney and medical records are reviewed by the arbitrator. We usually receive favorable rulings, requiring the insurance carrier to honor its obligations to the policyholder and pay the disputed medical bills. The majority of the cost of the arbitration is borne by the insurance company. The policyholder/client’s share of the arbitration cost is only $100.00.

The second approach is to file a lawsuit in an Oregon court to compel payment by your insurance company. Under this approach we can request attorney fees when we prevail at trial. The threat of attorney fees can, at times, motivate insurance companies to pay your denied medical bills.

Some law firms recommend to their clients that they not challenge the PIP denial. We believe this weakens the overall case against the at-fault insurance company and allows the PIP carrier to escape its contractual obligations. Consequently, we always believe in fighting for our clients and pursuing arbitration whenever our client’s insurance company attempts to deny medical benefits.

-Chris MacNeil, motorcycle accident lawyer in Corvallis, Oregon

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