Medical Bill Recovery

Auto Accident Related Medical Bills should be Paid by Oregon Auto Insurance

Who pays my accident related medical bills after an auto accident? All Oregon insurance policies commencing after January 1, 2016 must provide $15,000.00 of no-fault Personal Injury Protection (PIP) benefits for all reasonable and necessary medical care within the two years after an automobile accident. See ORS 742.524(1)(a). You can also pay your auto insurance company for higher PIP benefits. Note: For Oregon policies commencing prior to January 1, 2016, all PIP benefits must be used within one year.

Shouldn’t the at-fault driver’s insurance company pay my medical bills? Yes, eventually, your insurance company must elect to enter into inter-insurer arbitration with the at-fault driver’s insurance company or have your attorney include them in any demands for recovery or lawsuit. The public policy reason behind your own insurance company initially paying the medical bills is to avoid delays in treatment. If liability had to be determined before medical bills were paid, people would inevitably wait years for urgently needed medical treatment. Or, their bills would rack up fees and interest and destroy one’s credit while in collections.

How long does my auto insurance company have to pay my medical bills? After receiving a medical bill and supporting medical records from your medical provider, your insurance company must pay the medical bill or provide written notice of the reason for the denial within 60 days. see ORS 742.528

What if my auto insurance company simply ignores all auto accident related medical billings? If your insurance company ignores billings from your medical providers, your medical bills will be presumed reasonable after 60 days under ORS 742.524(1)(a). If you file a lawsuit, this means that you have a greater chance of winning. If you wait six months from the date your auto insurance company received your medical bills and supporting medical records, attorney fee provisions may apply under ORS 742.061. Clark Law and Associates can help with filing a lawsuit and work with your medical provider to prepare for a lawsuit.

What if my insurance company does not pay the first $15,000.00 of my accident-related medical bills incurred with the first year?
If your insurance company fails to pay your automobile accident-related medical bills as required under ORS 742.524(1)(a), or your policy amount, whichever is higher, our firm can assist you, regardless of who was at-fault for the vehicle accident.

If my insurance company fails to pay my auto accident related medical bills as required under Oregon law, how is your firm paid? Attorney fee provisions under ORS 742.061 may apply when the following conditions are met:

  • You were insured at the time of the vehicle accident.
  • You have outstanding bills incurred within the first year after the accident that have been billed to the auto insurance company over six months ago with supporting documentation, such as medical records.
  • Someone in your doctor’s office can make an affidavit that the insurance company was billed over six months ago along with supporting documentation for your accident related medical bills.
  • Your doctor has office procedures in place to document when insurance companies are billed.
  • These bills have been outstanding for less than six years.
  • Your insurance company has not agreed to submit to binding arbitration within 6 months after a denial of a bill.

If we cannot verify that your medical provider has billed your insurance company and provided supporting documentation, our firm will send out a proof of loss. A “proof of loss” for your accident-related medical expenses usually consists of medical records, medical bills properly coded and documentation of mailing. Prior or subsequent medical records in relation to the same bodily part or condition may also be required as part of a proof of losss. However, if the insurance company pays within 6 months of our proof of loss, then the attorney fee provision won’t apply and our firm will take our contractual percentage and costs.

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