Coverage Questions

1) My Oregon auto policy does not list all PIP benefits mentioned above. What coverage do I have?

Regardless of the coverage shown on the face of your Oregon auto policy you get at least the coverage Oregon law requires. See, ORS 806.070. Insurance policies, purporting to provide less insurance than Oregon law requires will be reformed to provide at least Oregon minimum limits. See, Viking Insurance Co. v. Perotti, 308 OR 623 (1989).

TIP: If you purchased an auto policy purporting to provide less that Oregon’s minimum limits, consider filing a complaint against the insurance company with the Oregon Department of Insurance & Finance. To do that go to: www.oregon.gov/DCBS/insurance/gethelp/Pages/fileacomplaint.aspx

2) A family member of the driver at fault was injured in an auto crash. Is there liability coverage?

Yes. There is coverage for such a passenger in Oregon in spite of policy language to the
contrary.

Many personal auto liability policies contain an exclusion that reads:

“We do not furnish Liability Coverage for you or any family member for bodily injury to you or any family member.”

The above language is commonly known as the “family member exclusion”. ORS 742.450 (8) clarifies that, in Oregon, the “family member exclusion” is invalid. Stated differently, it is illegal in Oregon to exclude liability coverage for a family member riding in the insured vehicle..

3) Am I bound by my insurer’s liability decision?

No. For purposes of its PIP reimbursement, your own auto insurer may take the position you were at fault. You also have a claims against the bad driver. In presenting your claims you are not bound by your insurer’s liability determination.

4) Do I need to repay health insurance for auto crash related medical costs?

Yes in most cases health insurance must be repaid. Oregon and Washington states generally recognize health insurance “subrogation” rights (reimbursement) for medical costs caused the negligence of a third party. California does not. By giving the insured person’s recovery right priority, California is known as a “make whole” state.

In Oregon and Washington health insurance companies don’t really pay auto accident medical charges at all. More accurately, health insurers “loan” the injured person money for crash medicals with expectation of repayment at case conclusion. Ignoring the health insurer’s subrogation right may expose the injured person to civil liability down the road.

TIP: A health insurer may be willing to reduce its subrogation claim under the right circumstances and with gentle, persistent pressure.

5) Under what circumstances may an insurer declare my vehicle a total loss?

The insurance company repairing your vehicle may declare it a total loss if the cost to repair the vehicle exceeds a certain percentage of the total value of the vehicle. If your own insurer is paying for the repairs, your policy will set out that percentage and explain the circumstances when the vehicle may be “totaled”.

If someone else’s insurer is paying for the repairs, you should ask the adjuster how it determines your vehicle to be a total as you won’t be privy to the terms of the policy. Ask the adjuster what is their: 1. assumed post- crash vehicle value; 2. Assumed cost of repair; 3. Percentage the cost of repair to total value in order for them to declare a total loss (usually 70, 80 or 90%).

TIP: Then (and this is the important part) check the values they assume and their math.Considering hiring an appraiser to contest valuation if needed and when costs justify. Ask the insurer for written justification explanation of the values the insurer assumes.