What Do You Do if Your Oregon Auto Insurer Improperly Denies or Delays Your Claim?

In the realm of insurance, the relationship between policyholders and insurance companies is founded on trust. Policyholders expect their insurers to act in good faith, promptly handling claims and providing the coverage promised in their policies. However, what happens when this trust is violated? In Oregon insurance bad faith can leave individuals grappling with denied claims, delayed payments, and unfair treatment.

One area where this often comes to the forefront is when an insurer unlawfully denies or cuts off personal injury protection (PIP) benefits. This usually occurs when there is a “file review” or an “insurance medical exam” by a medical provider that is hired by the insurer and concludes future medical treatment is not necessary or related to the crash. Bad faith conduct also arises when the insurer does not process bills in time or the insurer makes your medical providers jump through unnecessary hoops. This may result in teh providers passing the bills on to you.

What is Insurance Bad Faith?

Insurance bad faith occurs when an insurance company fails to uphold its contractual obligations to its policyholders. This can manifest in various forms, including unjustified claim denials, unreasonable delays in claim processing, inadequate investigations, and deceptive practices. When an insurer acts in bad faith, it undermines the fundamental purpose of insurance, which is to provide financial protection and peace of mind to policyholders in times of need. In Oregon bad faith is written into the law in the Unfair Claims Settlement Practices Act found in ORS 746.230. The recent court decision in Moody v. Federal Insurance Company, has provided persons insured by an Oregon policy a legal remedy to obtain financial compensation when an insurer violates Oregon’s Unfair Claims Settlement Practices Act.

Understanding Personal Injury Protection (PIP) Benefits

Personal Injury Protection (PIP) is a type of coverage that is mandated in some states, including Oregon, as part of auto insurance policies. PIP benefits are designed to provide prompt payment for medical expenses and lost wages resulting from injuries sustained in a car accident, regardless of who was at fault. In Oregon, drivers are required to carry a minimum of $15,000.00 of PIP coverage that pays crash related medical expenses as part of their auto insurance policies.

The Tools Insurance Companies Use to Wrongfully Deny PIP Benefits:

While PIP coverage is intended to provide swift and efficient compensation for accident-related injuries, navigating the claims process can sometimes be fraught with challenges. Insurance companies may engage in tactics aimed at minimizing their financial exposure, including:

1. Unjustified Claim Denials: Insurers may wrongfully deny valid PIP claims, citing vague policy language or alleging that the injuries are not covered under the policy.

2. Delaying Claim Processing: Delays in processing PIP claims can exacerbate financial strain for injured individuals who rely on timely reimbursement for medical expenses and lost wages.

3. Undervaluing Claims: Insurance companies may offer settlements that do not adequately compensate injured parties for their medical costs, lost income, and pain and suffering.

4. Inadequate Investigations: Insurers have a duty to conduct thorough and fair investigations into PIP claims. However, they may cut corners or overlook crucial evidence to justify denying or undervaluing claims.

Protecting Your Rights

If you believe that your insurer is acting in bad faith regarding your PIP claim, it is essential to take proactive steps to protect your rights:

1. Document Everything: Keep detailed records of all communication with your insurance company, including emails, letters, and phone calls. Document your medical expenses, treatments, and any correspondence related to your claim.

2. Know Your Policy: Familiarize yourself with the terms and conditions of your insurance policy, including the extent of your PIP coverage and any limitations or exclusions that may apply.

3. Seek Legal Guidance: If you encounter difficulties with your PIP claim, consider consulting with an experienced personal injury attorney, such as Jeremiah Ross, who can advocate on your behalf. Ross Law can review your case, negotiate with the insurance company, and, if necessary, pursue legal action to enforce your rights.

Conclusion

Insurance bad faith can have devastating consequences for individuals seeking compensation for injuries sustained in car accidents. Understanding your rights under Oregon's PIP coverage and recognizing the signs of insurer misconduct are crucial steps in safeguarding your interests. By staying informed, documenting your expenses, and seeking legal guidance when needed, you can assert your rights and pursue fair treatment from your insurance company. Remember, you deserve prompt and equitable compensation for your injuries, and insurance bad faith should never stand in the way of justice.

Please remember this blog post is for informational purposes only and is not considered to be legal advice. Please contact an Oregon Personal Injury lawyer such as Jeremiah Ross at 503.224.1658 to discuss your insurance denial. Please remember the law is constanty changing, and this blog post is not updated regularly.

2019 Was An Incredible Year for Ross Law's Clients!

2019 was an amazing year for Ross Law and our Clients! Ross Law worked tirelessly to assist Oregonians to obtain maximum compensation for their Personal Injury cases, wrongful death cases, crime victim cases, insurance disputes, and consumer cases.

Below is a rundown on some of the results from 2019:

• $2,225,000.00 Jury Trial Verdict where Jeremiah Ross co-counseled a two-week medical malpractice & Patient Safety case with another attorney against one of Oregon’s top medical malpractice defense law firms. Click HERE for more information on that case.

• Significant Settlement in Case Against DHS and others in a case where our young client was abused and neglected while she was in the legal custody of the Department of Human Services. Click HERE for more information on the lawsuit against Oregon’s DHS & CPS.

• Confidential Settlement in Wrongful Death Case against a mental health provider whose negligence resulted in a schizophrenic’s suicide;

• Confidential Settlement received in a civil domestic violence case against an abuser. Ross Law represented a young survivor of domestic violence and filed a lawsuit against the abuser after he was convicted of his crimes in criminal court. As a crime victim’s lawyer, Ross Law fought tirelessly to cut through very complex legal issues to ensure the victim received compensation to regain the power and control of her life.

• $100,000.00 settlement for Ross Law’s client who was backed over by a vehicle while she was urinating behind the vehicle due to her intoxication. The bad driver’s insurance company denied any liability until Jeremiah Ross litigated the matter.

• Insurance Benefits obtained for a client who the insurer denied personal injury protection benefits to a cyclist who was thrown into a car at a stop sign. The stopped vehicle’s insurer denied benefits based on its interpretation of the law that the cyclist had to be “struck by” the vehicle. The judge ordered the Insurance Company to pay the cyclist $15,000.00 in denied insurance benefits and the cyclist’s costs and attorney fees. Click HERE for more information on that case.

• Insurance Benefits obtained for a client who was wrongfully denied Personal Injury Protection benefits from USAA and Auto Injury Solutions. The judge ordered USAA to pay the outstanding benefits and our client’s costs and attorney fees. Click HERE for more information on that case.

• Numerous favorable Settlements in Lemon Law and Auto Dealership Fraud Cases. These settlements included cash that was paid directly to our clients by the dealership, buy-backs of vehicles, unwinding car deals, and the dealership or auto manufacturers paid Ross Law’s consumer client’s costs and attorney fees.

There were many other amazing results for or clients! Please remember that results for all clients will vary. Each case is different. Some cases are better than others. If you, or someone you know, needs a personal injury lawyer, wrongful death lawyer, crime victim’s lawyer, or consumer lawyer please call Ross Law at 503.224.1658.

Ross Law Is Open!

It has been a crazy couple of weeks. COVID-19 was an unknown term three weeks ago, now we are working to “flatten the curve” by staying home and social distancing in an effort to slow the spread of this virus. Here at Ross Law we are working hard to continue to provide exceptional client services while working remotely. Personal Injury case, Insurance Disputes, and Crime Victim case evaluations and meetings will now be by phone and email. Consumer consultations and auto fraud case evaluations will also occur on the telephone and email. This is less than ideal, but we are adapting as this situation unfolds.

Things may take a little longer because insurance companies and medical providers take longer to process claims and get us records, but we will keep moving forward. Please contact Ross Law at 503.224.1658 to discuss your personal injury case, insurance denial, consumer or auto fraud case. Oregon Personal Injury and Consumer lawyer Jeremiah Ross is happy to assist Oregonians during these difficult times.

Can Cyclists Get PIP Insurance Coverage if They Are Thrown Into a Stationary Vehicle?

Answer: Yes, an Oregon cyclist can get No-Fault PIP medical coverage if they are thrown into a Stationary Car waiting at a Stop Sign. See below for details.

Here at Ross Law, we are constantly fighting to ensure that insurance companies comply with the law and the terms of their insurance policies. This often results in interesting litigation where we get to geek out over what the language in the law and policies actually mean. (Click Here to Read about our USAA Dispute)

For example, we recently represented a cyclist who was hit by a car while lawfully riding his bike on the street. The impact of the crash threw the cyclist into a stationary vehicle waiting at a stoplight. State Farm insured the stationary vehicle.

The law allows cyclists to be eligible for up to $15,000.00 in no-fault PIP medical coverage in certain circumstances. Our cyclist client was eligible for PIP medical benefits, but State Farm denied our request for coverage because they claimed the law required that their insured’s vehicle is moving in order for the cyclist to be “struck by” the insured vehicle.

We obviously had a different take on State Farm’s reading of the law. ORS 742.520(1) and (2) were enacted to ensure that Oregon’s pedestrians had no-fault PIP coverage to pay their medical bills in the event they were “struck by” a vehicle. Cyclists are considered pedestrians under Oregon’s PIP law. As a result, it was our position that in order to fulfill the legislative intent that cyclists medical bills get paid by no-fault insurance; the court had to interpret the phrase “struck by” as the forceful collision between two objects. One could be stationary or both could be moving. The court agreed with our position and granted our Motion for Summary judgment. This means that our cyclist client will be reimbursed $15,000.00 for the medical bills that he paid out of his pocket.

State Farm also likely has to pay our cyclist client’s attorney fees. That means that the cyclist will collect the entire $15,000.00. This is important as it means that the cyclist basically received free legal representation because the insurer that took an unreasonable position should have to pay his legal fees. The court will decide that issue in the near future.

State Farm may appeal the matter. If they do then we are ready to continue to fight. This was a big win. Future cyclists should benefit from our work and won’t be denied PIP benefits simply because the insured’s vehicle was not moving at the time of the crash.

If you are injured while riding your bike and are trying to get your medical bills paid after a crash with a vehicle, call Ross Law at 503.224.1658. Jeremiah Ross is a personal injury lawyer that represents cyclists throughout Oregon and is happy to provide a free personal injury and insurance case evaluation.

Please remember that all cases are different and your facts may not entitle you to PIP coverage if you were a cyclist or pedestrian that was hit by a car. Remember there is a priority of coverage issues that mean if you have PIP insurance of Health Insurance then you may not be eligible to get PIP insurance from the vehicle that struck you. Please also remember the law is constantly changing so please contact a lawyer to obtain legal advice. This post is not intended to be legal advice and is for general education purposes.

5 Things Inured Cyclists Should Know About PIP and Getting Medical Bills Paid

Ross Law often fields calls from cyclists that were injured by a negligent driver (aka the “bad driver.) Many times the injured bike rider is struggling to figure out the insurance issues and how they can, 1) recover for their lost wages, and 2) get their medical bills paid. Whether or not a person can recover for lost wages (Wage Benefits) or get their medical bills (Medical Benefits) paid largely depends on whether or not they have PIP (Personal Injury Protection) insurance available to them. If you have questions about what PIP insurance is or how much you can receive in PIP, please CLICK HERE to Ross Law’s previous article on Oregon PIP benefits. The big thing to remember about PIP is that it is “no-fault” so it applies regardless of who is at fault.

The following should hopefully assist injured Oregon cyclists to navigate the insurance issues if they were injured in a crash with a bad driver.:

1) Does an Injured Cyclist Have PIP Insurance Coverage? Maybe. Insurance policies issued in Oregon are legally required to provide personal injury protection (PIP) coverage in certain scenarios. Generally, PIP will provide coverage for a cyclist that is injured in a crash with a bad driver. However, it is not that simple. It also becomes a matter of priority of insurance policies. That will be discussed below.

2) If a cyclist was injured in a crash with a bad driver, does the injured cyclist’s PIP Pay for lost wages and medical bills? Probably. Under Oregon law the injured cyclist’s own PIP insurance from the cyclists’s auto policy will pay first. If the injured cyclist does not have their own Oregon Auto Insurance Policy then the injured cyclist’s health insurance should typically pay. Lastly, if the injured cyclist does not have an Oregon Auto Insurance Policy or health insurance then PIP coverage can be obtained through the bad driver’s Oregon Auto Insurance Policy.

3) Can an injured cyclist get PIP benefits if they do not have their own Oregon Auto Insurance Policy? Maybe. It is very common for an injured cyclist to not have their own auto insurance policy. As a result, they may think that they do not have access to PIP benefits. An injured cyclist may be able to get PIP insurance coverage through a resident relative or through a ride-sharing program. If the injured cyclist has no PIP coverage of their own, then the injured cyclist can have access to the bad driver’s PIP to pay medical bills if 1) the injured cyclist does not have any health insurance coverage or 2) the injured cyclist’s health insurer does not pay the full amount of the medical bills (think co-pay expenses or out of network expenses). The bad driver’s PIP may also be responsible for paying PIP wage loss benefits if the injured cyclist cannot obtain PIP coverage of their own.

4) Why Would The Bad Driver’s Insurance Company Refuse to Pay PIP Medical Benefits to an Injured Cyclist? Usually, when the bad driver’s insurer is refusing to provide PIP coverage to an injured cyclist it is because the bad driver’s insurer is not convinced that: 1) the injured cyclist does not have PIP coverage under an Oregon Automobile Insurance Policy, or 2) the injured cyclist does not have health insurance. The bad driver’s insurer will often send out a document titled “Declaration of No Coverage” or something similar for the injured cyclist to sign. If you receive one of these documents you should immediately call a Personal Injury Lawyer to discuss it. Additionally, the bad driver’s insurer may claim that they are only paying reasonable and necessary medical expenses. They may deny payment of a bill because they claim it was not reasonable or necessary. Should that occur, please contact a Personal Injury Lawyer to discuss it.

5) How Does PIP Work if Your Health Insurance Is Paying Some Medical Expenses But Not All? Remember that if the injured cyclist does not have their own PIP insurance but they have health insurance then the health insurance becomes primary coverage over the bad driver’s PIP. As a result, the bad driver’s PIP will only pay medical expenses that are not paid by your insurance company. This can be frustrating as a practical matter because people often have to pay co-pays at the time they seek treatment. If this occurs, then the bad driver’s PIP insurer should reimburse the injured cyclist for the paid co-pay once the bad driver’s PIP insurer receives proof that it was paid. The bad driver’s PIP will usually send a check directly to the injured cyclist a couple of weeks it receives proof of payment (aka proof of loss.)

If you or someone you know were a cyclist injured in a crash with a bad driver, please call Oregon Personal Injury Lawyer Jeremiah Ross at 503.224.1658. Jeremiah Ross has represented injured cyclists for years and is happy to provide a free case evaluation. Jeremiah Ross has also successfully sued numerous insurance companies for failing to provide Personal Injury Protection benefits to injured Oregonians. Pleae remember the law is constantly changing and this blog article is for information only. Please contact a personal injury lawyer if you have questions, comments, or concerns. Do not rely solely on this post.

Ross Law Prevails in Lawsuit Against USAA after USAA's "Deplorable" Conduct!

Another win at Ross Law PDX! Last year our client was injured in a car crash. Her insurer, USAA Casualty Insurance Company, was obligated under Oregon Law and her insurance policy to pay up to $15,000.00 of her reasonable and necessary crash related medical expenses. These are commonly referred to as PIP benefits. After a few months USAA stopped paying reasonable and necessary medical bills. USAA also ignored the law that required USAA to provide written notice of the denials to our client and our office. As a result, our client was incurring medical expenses and had no idea that USAA would refuse to pay them.

Unbeknownst to our client USAA’s vendor Auto Injury Solutions (AIS) had been recommending that USAA refuse to pay the bills. What appears to have happened was USAA’s adjuster arbitrarily set a reserve (think of this as the budget for the claim) of $5,000.00 to cover our client’s medical expenses. Once our client’s bills exceeded the $5,000 reserve, it triggered AIS to conduct further detailed review on all subsequent bills. Not surprisingly AIS told USAA’s adjuster to refuse to pay all subsequent bills. USAA did as AIS informed them to do and denied the bills without reaching out to our client’s medical providers to get further clarification on her injuries and treatment, or reaching out to our office for more information. As a result, thousands of dollars of crash related medical expenses went unpaid.

We had no choice at that point and filed a lawsuit against USAA Casualty Insurance Company on our client’s behalf. Our client did not have to worry about paying the costs and attorney fees to file the lawsuit because Oregon Law allows for the insured to recover costs in attorney fees in situations like this. We filed the lawsuit in Mulnomah County Circuit Court under case number 18CV27752.

Shortly after the lawsuit was filed USAA suddenly paid, without explanation, almost two thousand dollars of outstanding Medical bills. However, USAA refused to pay for a few visits to a chiropractor. USAA then blamed Auto Injury Solutions and our client for USAA’s failure to pay the medical expenses. Apparently USAA decided to “deny, deny, deny, and blame the other guy.” In doing so, it appeared USAA completely disregarded its’ contractual and legal obligation to pay these medical bills under the Insurance Policy and Oregon Law.

USAA then steadfastly refused to make a fair settlement offer. Instead, USAA attempted to settle the case by forcing our client to sign a confidentiality and non-disparagement agreement in exchange for payment of benefits that she was entitled to. USAA also refused to pay the full amount of the incurred costs and attorney fees. It was our belief that USAA was attempting to strip our client’s First Amendment Rights in an effort to conceal USAA’s attempts to profit from unlawfully denying active duty military, veterans, and their families insurance benefits. Our client stood firm and refused to be gagged by USAA’s corporate greed.

We then took a deposition of USAA’s corporate representative. He gave some troubling testimony. This included claiming that he received a letter from a physician hired by AIS that recommended that he deny the bills. This is called a “file review” letter or USAA calls it a “PHAD” (physician denial letter). However, USAA never sent that letter to anyone and claims it simply disappeared. USAA’s corporate representative confirmed that this has never happened before. USAA’s corporate representative also testified that he reviewed the written notices of the denials. These are commonly referred to as “Explanation of Benefits forms,” or “EOB’s.” These were the documents that USAA was required by law to send to our client or our office but failed to. Despite testifying the EOB’s existed and were reviewed, USAA refused to produce them despite our formal legal request and various follow up letters to USAA’s lawyers.

As a result of USAA’s shenanigans we filed motions with the arbitrator to compel them to produce the information they were concealing. At this point USAA had three lawyers on the case. We also filed motions for sanctions to punish USAA for their unscrupulous and shameful litigation tactics. In April 2019, on the last business day before the hearing on the motions for sanctions, USAA suddenly “tendered” the disputed amount of the medical bills. This means that we had won and USAA would send us a check to pay the amount of the remaining disputed bills.

However, that is not the end of the story. Despite USAA stating in writing and orally that it would send the check to pay the roughly $3,700.00 of wrongfully denied bills, USAA didn’t pay. USAA also took issue with the Arbitrator awarding roughly $59,000.00 in attorney fees and costs. The arbitrator stated that USAA’s conduct was “deplorable.”

USAA appealed the arbitrator’s decision and tried to bury the arbitrator’s written findings of facts which outline USAA’s shameful conduct. USAA was finally able to convince the court that USAA should only pay our client’s attorney fees of roughly $39,000.00. Both the Judge and the Arbitrator had serious issues with the way USAA was treating its insured and the way they chose to litigate this matter.

This was a big win for our client who was able to get thousands of dollars in medical debt wiped out. It was also a huge blow to USAA and their team of lawyers because it is clear that their unlawful PIP denials will cost them substantially if the right lawyer gets a hold of the case and forces them to explain why they are trying to screw their insured out of benefits.

If you, or someone you know, have been wrongfully wrongfully denied Personal Injury Protection benefits, or have been sent to an examination by your auto insurance company you should call an Oregon Insurance Lawyer at Ross Law PDX as soon as possible at 503.224.1658 to discuss your options. Jeremiah Ross is happy to represent clients in PIP denial cases on a contingency basis. As a Veteran, Jeremiah is happy to go to battle against USAA who hides behind a cloak of patriotism only to put profit over people.

Oregon Women Pay More For Car Insurance Than Oregon Men! Here is Why...

As an Oregon Personal Injury Lawyer and Consumer Lawyer, I am regularly asked by people if making a claim to their auto insurance will cause their insurance rates to go up. This is not an easy question to answer, because Insurance Companies are for profit businesses. As a result, Insurers are going to do what they feel is necessary in order to make a profit unless regulators or attorneys’ stop them. For example, GEICO was ordered to pay $23,000,000.00 to one of their insureds for GEICO failing to pay benefits, and denying payments on a whim. State Farm agreed to pay its customers $250,000,000 (That is not a typo) in order to avoid a racketeering trial in which customers claimed that State Farm was rigging an election for a Judge that had made favorable rulings for State Farm. USAA agreed to pay $39,000,000.00 to settle a lawsuit filed by its insureds (Veterans, Active Duty Military, and their families). These cases are evidence that some Insurance Companies are willing to skirt the law and disregard the moral high-ground in an effort to make a profit. Another example of insurers putting profit over people is how insurance companies are charging Oregon women more than Oregon men for auto insurance.

A recent study by an insurance search engine, The Zebra, found that Oregon women’ paid roughly $70.00 more for auto insurance last year than men did. A recent Pew Research study also came to the same conclusions on a national level. The studies found certain states prohibit gender based pricing, but Oregon is not one of them. What this means is that Insurers are at liberty to charge women more for insurance than men, and they do not have to have any justification for doing so.

The statistics support the fact that Oregon insurance companies are charging dramatically different rates for women than men. In 2016, insurers charged Oregon women $13.00 more for auto insurance than men. However, in 2018 that number inexplicably jumped to women paying $71.00 more for auto insurance than men. Does that mean that women are more dangerous on the road than men if insurers are charging them more? The answer is no.

The data does not support the Insurance Industry’s decisions to charge women more for car insurance in 25 States. The Zebra study affirmed that women and men equally engage in distracted driving, so that could not be a basis to charge women more. Additionally, fatality statistics do not support the insurance industry’s decision to overcharge Oregon women for car insurance. For example, men are the drivers in the vast majority of fatal Driving Under the Influence (DUII) crashes. Men also cause more speed related wrongful deaths on the road. The statistics show that men are riskier to insure than women.

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Additionally, different companies charge different rates to similarly situated women throughout the country. For example, State Farm charged middle aged women the same as men. However, GEICO charged middle aged women 16% more than men. This is an important statistic. If insurance companies rates reflect the risk of a particular demographic of drivers then there would not be such a large disparity between the rates particular insurance companies are charging.

Then why are insurance companies charging women the so called “pink tax” to insure their vehicles? Why have the number of states where women pay more than men doubled in the past two years? The answer is simple, profits. The insurance industry is operating in a relaxed regulatory environment that permits them to take actions that will make their companies more profitable, even if that means imposing the “pink tax” on women.

For example, the insurance industry knows that Oregon does not have a bad faith claim, and Insurance Companies are specifically exempted from Oregon’s Unlawful Trade Practices Act (UTPA). The UTPA is a law that provides consumers a remedy if consumers are ripped off by a business. However, the insurance industry lobbied the legislature to be exempted from that law. As a result the insurance industry knows they are likely immune from any real consequences of arbitrarily charging women more for insurance than men.

Despite the insurance industry’s protections, here at Ross Law we will sue insurance companies if a person has been wronged by an insurer and there is a recognized legal remedy for that person. For example we regularly sue insurance companies on behalf of people whose automobile insurers deny paying personal injury protection benefits. We also sue insurance companies to collect uninsured and under-insured motorist benefits. Ross Law has also sued insurance companies for denying insurance coverage for a car crash.

If you or someone you know has an issue with an auto insurance company please call Jeremiah Ross at 503.224.1658 for your free case evaluation. Ross Law PDX is happy to represent Oregonians in many types insurance disputes.

Please note that Ross Law PDX is not affiliated with The Zebra or the Pew Research Center. Please refer to the links in the article for the most accurate information. Please note that this blog may be considered attorney advertising and expresses the opinions of this law office. Please remember that the law is constantly changing and insurance issues are usually very complicated. Please consult with an Oregon attorney if you have a dispute with an Oregon insurer. Do not simply rely on this blog post.