Personal Injury Protection

About personal injury protection benefits

Personal injury protection benefits, commonly abbreviated PIP, pay the medical expenses and certain other losses of people injured in a motor vehicle collision. It is a first-party coverage. Benefits are paid regardless of who caused the collision.

Oregon requires it. Under ORS 742.520, every motor vehicle liability policy issued for delivery in this state covering a private passenger motor vehicle must provide PIP benefits. The coverage reaches the named insured, family members residing in the same household, certain children being reared as the insured’s own, passengers occupying the insured vehicle, and pedestrians struck by it. Transportation network company drivers and taxi drivers are covered under separate provisions of the same section.

ORS 742.524 provides five types of benefits:

• Medical expenses. All reasonable and necessary expenses of medical, hospital, dental, surgical, ambulance and prosthetic services incurred within two years after the date of injury, up to $15,000 in the aggregate.
• Lost income. If the injured person is usually engaged in a remunerative occupation and disability continues at least 14 days, 70 percent of lost income, capped at $3,000 per month and 52 weeks in the aggregate.
• Essential services. For an injured person not usually engaged in a remunerative occupation, the cost of essential services performed by someone outside the household, capped at $30 per day and 52 weeks.
• Funeral expenses. Reasonable and necessary funeral expenses incurred within one year, up to $5,000.
• Child care. For an injured parent of a minor child hospitalized at least 24 hours, $25 per day, up to $750.

An insurer may offer the medical, income and essential services benefits with deductibles of up to $250.

More favorable benefits are permitted. ORS 742.532 provides that nothing in the PIP statutes is intended to prevent an insurer from providing more favorable benefits than those described in ORS 742.520, 742.524 and 742.530. The uninsured motorist statutes are built the same way. ORS 742.504 requires every policy to provide coverage that in each instance is no less favorable in any respect to the insured than the provisions the section goes on to set out. In Vega v. Farmers Ins. Co., 323 Or 291, 918 P2d 95 (1996), the Oregon Supreme Court read that language to invalidate an exhaustion clause, reasoning that a term could not be less favorable than the coverage set out by the statute. The 1997 legislature answered by codifying an exhaustion clause into ORS 742.504, which changed the result without disturbing the structure. Benefits may be written above what the statutes describe. They may not be written below.

Medical charges are presumed reasonable and necessary. Under ORS 742.524, that presumption holds unless the provider receives notice of denial within 60 calendar days after the insurer receives notice of the claim. ORS 742.528 separately requires the insurer to give written notice of any denial to the insured within the same 60 days, stating the reason and explaining how to contest it. The 60-day count pauses if the provider does not answer the insurer’s written questions within 10 days.

Primary or excess. ORS 742.526 determines which policy pays first. Benefits are primary for the insured, household family members and passengers injured while occupying the insured vehicle, and for the insured and household family members injured as pedestrians. They are excess for the insured and household family members injured while occupying a vehicle not insured under the policy, and for other pedestrians struck by the insured vehicle.

The full text of all seventeen sections, every prior version back to enactment, and the legislative history are on the statute pages below.