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.

Jeremiah Ross Selected as a SuperLawyer! Again....

2019 was an incredible year for Ross Law and Jeremiah Ross! Ross Law fought tirelessly for our clients in personal injury cases, insurance disputes, wrongful death cases, medical malpractice cases, lemon law cases, auto dealership fraud cases, and crime victim cases. Ross law achieved incredible results for our clients.

Peers selected Jeremiah Ross as a 2020 SuperLawyer for personal injury general plaintiff’s practice. This is the fifth year Jeremiah Ross has been recognized by SuperLawyers.

• 2020 Oregon Super Lawyers

• 2019 Oregon Super Lawyers

• 2018 Oregon Super Lawyers

• 2017 Oregon Rising Stars

• 2016 Oregon Rising Stars

We look forward to continuing with the amazing success Ross Law has had and are thankful to be rated as a SuperLawyer!

Please remember the results may vary for each client. Each case is different. If you or someone you know needs to speak with a Personal Injury Lawyer, Wrongful Death Lawyer, Crime Victim Lawyer, or Consumer Lawyer, please call 503.224.1658 to speak with Ross Law. This post may be considered Attorney Advertising.

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.

Ross Law files Suit against USAA Casualty Insurance for Wrongfully Denying PIP Benefits

USAA has been my insurance company my entire adult life. They market themselves as supporters of the military and veterans. That may be the case, but as a personal injury lawyer, I often witness USAA doing anything they can to deny veterans and their families personal injury protection benefits. As a result USAA is often the target of PIP lawsuits in which the insured is forced to sue USAA for wrongfully denying benefits in an effort to obtain their insurance benefits. Recently Ross Law PDX filed a lawsuit against USAA Casualty Insurance Company in an effort to obtain our client PIP benefits.

In our case USAA through Auto Injury Solutions sent our client’s medical record out to a hired gun doctor to give an opinion that my client was not hurt as bad as she claims to have been. This is often referred to as a “record review” or “file review.” USAA then failed to provide any notice that it was denying our client’s bills or explain why. We have alleged this is in violation of Oregon Law and its contract. USAA appears to have taken a position of vigorously defending the action.

If you or someone you know have been wrongfully been denied PIP benefits, please call Oregon Personal Injury Lawyer Jeremiah Ross at 503.224.1658. Ross Law PDX is happy to fight insurance companies that have wrongfully denied insurance claims. Please note that the litigation noted above is pending, and the opinions espoused by me on this blog are my opinions and based on my personal experiences.