Answering the Most Frequently Asked Questions Is a Good Start, But We Decided to Answer The Most Important Questions Too. Learn What You Need to Know About Your Injury and Disability Claim.

The Quick Answer

It depends! 

Oregon Injury Claims and Health Insurance

Whether your health insurer gets involved with your injury claim depends on whether there is other insurance that is responsible to cover your medical expenses, and if so, the amount of available coverage.  This is because your health insurance will exclude coverage where another insurance is involved, and is in the "front of the line" for covering medical expenses.  The insurance company at the front of the line to pay medical expenses is considered "primary."  Here are a few examples:

If you are injured in an auto collision in Oregon, and the car is an Oregon insured car, then you have no fault medical coverage under the auto policy.  That coverage is first in line to pay medical benefits.  However, an Oregon driver need only carry $15,000.00 in coverage for medical expenses, so if you are seriously injured, that coverage will be paid out, or "exhausted," leaving you with a lot of unpaid medical bills.

You may have been injured on someone else's property, and in a lot of cases, homeowner and business policies offer a "no-fault" medical coverage that pays up to a certain amount of medical expense, regardless of fault.  After that coverage is exhausted, you must look to your health insurer to cover medical bills.

How Health Insurers Protect Themselves

Most health insurance is regulated by federal statute, and that statute gives the health insurer a lot of room to write the health plan.  Health insurers will exclude coverage for injuries suffered in an auto collision where there is health coverage in the auto policy, or where the injury was caused by the fault of some other person.  The health insurer scans your medical records to see if there is a possible injury claim against an at fault party.  If it picks up the right terms (think "car wreck," or "fall"), then it sends you a questionnaire to find out if you are planning to make a claim.  Under the health plan terms, you must fill out the form, and if you do intend to pursue a claim, the health plan will only pay accident related medical expenses if you agree to reimburse the health plan for the medical bills it paid out of any money you recover from the at fault party or their insurer.

In an auto injury claim, you will have to provide the health plan proof that your auto policy has paid out all available no fault medical benefits.

Paying Back the Health Plan

Some health plans expect you to pay back every penny in medical benefits it paid, regardless of the amount you recover from the at fault insurer.  Some health plans even argue that it can deny future accident related medical expenses up to the amount of your overall settlement.  Some health plans will negotiate the reimbursement claim while agreeing to cover future care.  The law is always changing in this area.

If you do not pay back your health plan, it could file a lawsuit against you to recover the benefits it paid, and attorney fees. 

Medicare

Medicare, like any other health plan, will seek reimbursement for any accident related medical benefits.  However, Medicare is a part of the federal government, and has its own rules for recovering the medical expenses it paid for injury related care.  If you do not reimburse Medicare, it can also file a lawsuit against you, and can claim three times the amount of injury related medical benefits it provided.

Questions

If you have an Oregon injury claim and have questions about medical bills or health insurance, contact us.  We help people through these issues every day.

What is an MRI?

An MRI or "magnetic resonance imaging," is an image of the body's internal structures captured through magnetic waves.  MRI machines are taking better images all the time.  Functional MRIs, also referred to as fMRIs, track chemical reactions in the body, like blood flow. We have conferred with doctors who can show us a three dimensional image of a neck, including all the ligaments, discs and other soft tissues, and move the image around on a computer screen to see the anatomy from all angles. 

 

The MRI in an Oregon Workers' Compensation Claim

So how does this affect an injury or workers' compensation claim?

Remember that the MRI is a diagnostic tool that helps your doctors to investigate the nature and extent of injury.  Doctors typically use the MRI to rule out a serious injury and develop a treatment plan.  Whether your doctor sends you to have an MRI depends on your symptoms and the physician's findings on an office examination.  Some physicians take a "wait and see approach" before requesting an MRI.  This is because some symptoms will diminish after an injury event, and there is no need to get an MRI immediately.  In other cases, an emergency room doctor may order an MRI right away because of serious injuries or findings.

In Oregon Workers' Compensation claims, MRI's are often critical because disputes center on what kind of injury a worker suffered on the job and whether the MRI findings are a result of the work injury.  This is important because workers' compensation insurers  usually only provide benefits for the actual medical condition the on the job injury caused.  This is called the "accepted condition."

Neck injuries are commonly diagnosed with MRI's.

When a doctor orders an MRI of the neck, the doctor is looking to see if there is any damage to the joint structures of the neck.  Between each neck bone is a "disc" that acts like a cushion.  The disc is hard and fibrous on the outside, and moist and softer on the inside.  Some doctors have described the inside portion of the disc as having the consistency of crab meat.  When a human neck is exposed to sufficient force, the moist inner part of the disc can be pushed through a tear in the outer layer of the disc, which is called a disc herniation.  Sometimes the force of an injury will push out the disc's outer layer, resulting in a protrusion, with the softer material in the disc's center staying in place.  Other times, the disc may bulge as a result of trauma.

Aging and genetics will also cause wear and tear of the ligaments and discs in the spinal column, and an MRI can sometimes show these changes.  Generally, doctors look at the color of the image as one marker to determine whether the changes are recent, or have been in place for several months, even years.  These kinds of conclusions are based on the radiologist's interpretation of the image.  An MRI can also show an injury that worsens degenerative changes in the spinal column.  This can be a big issue in an Oregon Workers' Compensation claim because if a "pre-existing condition" combines with your on the job injury to contribute to a need for medical care or disability, the insurer may try to deny your claim, arguing that the pre-exiting condition is the main cause of a "combined condition's" need for treatment or disability.

Even though MRIs are objective, radiologists and doctors often disagree on what caused a particular finding.  Some radiologists do not believe that discs can herniate under force, and regularly consult for insurance companies.  Other doctors make their opinion based on what they see on the MRI, what the patient is saying about their symptoms, and what the treating doctor found in an office examination.

MRI's and the Oregon/Washington Injury Claim

In an auto collision case, MRIs will usually address one or two issues.  The first issue is whether the auto collision caused the injury or worsened something that was already present. 

MRIs also help lawyers prove whether an injury is permanent.  For example, if someone suffers a significant disc herniation, they may need to have the disc removed and the two neck bones fused together.  This is called a discectomy and fusion.  The surgeon is removing a joint from your neck, and fusing two bones together.  This surgery permanently restricts your neck motion, and makes the adjacent joints work overtime to hold up your head.  Those joints are now at increased risk for development of wear and tear damage, which we call arthritis, or degenerative disc disease.

Questions?

If you have an injury claim in Washington or Oregon, or if you were injured on the job in Oregon, contact us with questions.  We have learned a lot from doctors over the years, and help people facing these concerns all the time.

Yes, but you need to prove it.

Lost income is a form of what we call "economic" damages.  This means that the loss is verifiable, and can be proven with objective evidence.  In a simple case, you are injured, your doctor takes you off work, and you show through off work notes and wage information how much income you lost.  However, things can get trickier if you have a future income loss.

It's all about documentation.  You need to show your prior track record of earnings, and convince an insurance adjuster, or a jury, that you were set to either continue to earn comparable amounts, or even more.  You also need to keep in mind that if there is something else you can do to earn money, you need to do that in order to minimize your losses.

If you were not working at the time, you may be able to make a claim for future income losses, but it may be more challenging.  You may also have a claim for future lost earning capacity, which is not lost income, but compensation for lost income opportunities.  Many times, experts, like vocational counselors and economists will get involved in order to document these claims.

Questions?  Give us a call at 503-325-8600 to discuss this or any other issue you may have with your Oregon personal injury, or even a Washington injury claim.  We work on issues like this every day.

 

Mediation is simply another tool available to resolve any kind a dispute, including Oregon and Washington auto injury claims, or Oregon workers' compensation claims. Mediation is voluntary, and in my opinion, can only work of both parties are willing to approach the process in good faith.

A mediation is really just a meeting where all the parties get together to try and resolve a dispute.  Although everyone is in the same building many times, the parties to not actually meet face to face in most cases.

When I work with another attorney on an injury or workers' compensation claim, she and I will agree on a mediator.  We are usually hiring someone who knows the area of law that governs our case. For Oregon auto injury claims, we may use a Senior Judge or semi-retired attorney.  For Oregon Workers' Compensation claims, we may use an active Administrative Law Judge. (The Oregon Workers's Compensation Board has an active mediation program). 

Prior to the mediation session, I prepare a "pre-mediation position paper." In plain English, this is a letter to the mediator describing the case, including its strengths and weaknesses, and our position regarding settlement. Some mediators may ask for more information. Our philosophy is to include as much information as possible, but also to keep it to the point. Everything in this letter is confidential.

Every mediator has their own personal style. However, in our experience, the mediator will meet with each party individually, and then conduct "shuttle" diplomacy between the parties to get the case resolved.

Mediation is not an option in every case.  If you have a dispute involving an Oregon or Washington auto injury claim, or a Workers' Compensation claim, call us at 503-325-8600 to learn all your options.

Oregon and Washington each have their own set of rules and laws about what can be claimed if a person is injured in a car wreck or with any other kind of personal injury claim. The compensation you may claim is similar in both states, but carries different labels.

You have a claim for any medical expenses and lost income as a result of your injuries. This claim is not limited to past medical expenses and past lost income, but if documented, can include future lost income and future medical costs.

You also have a right to be compensated for the loss of your health. Oregon refers to this type of claim as "non-economic damage", and Washington refers to these claims as "general damages." Regardless of the name, the law recognizes that everyone has the right to be a whole healthy person. If somebody is careless, and causes another injury, the injured party may seek compensation for the loss of their health. Many people are familiar with the term "pain and suffering," but that only covers part of the compensation for the loss of health.

If you have any other questions about the type of claim you may have if you were injured in an auto collision, or the result of some other careless conduct, call us at 503-325-8600. We help people with these issues every day.

The general answer is "yes."  But there are procedures, and there are limits.

First, a bit of background.  Traditionally, the government has been immune from any kind of claim from a citizen, but the States of Oregon and Washington, as well as the Federal Government have passed statutes that have given the citizens permission to file lawsuits, but there are limits to the types of cases that may be brought, as well as the amount that can be claimed.  We will take it state by state, and then talk about federal claims.  Remember, this is not a complete explanation, but a good summary.

The State of Oregon

Oregon has a Tort Claims Act.  A "tort" is a civil wrong, like when someone ignores a stop sign, and causes an injury.  It is not necessarily a crime, but wrongful behavior, and so it is called a tort.

Oregon's tort claim statute requires that you provide appropriate notice to the responsible agency, or the state government within a certain period of time.  For an injury claim, you must provide written notice of your intent to file a claim within 180 days of the injury.  The notice has to describe the time, place and circumstances giving rise to the claim.  There has to be enough information that will allow the agency to investigate and determine whether or not it was responsible.  After you provide notice, you can file your claim in court.  You do not need to wait for any response.  You must file the claim within the time permitted under the statute.  For injury claims, the general time limit is two years, but that depends on the case.

There are limits on what kind of claims you can make, and also the amount you can claim.  For example, you can not make a claim that the governrment did not make the right kind of choice with the limited resources it has to deal with a problem.  This is called "discretionary immunity."  However, if there is a statute or rule that tells the government to do a certain thing a certain way, and it does not, that is not discretionary, it is a violation of the law.

There are also monetary limits on what you can claim and recover.  The Supreme Court found that the old limits were unconstitutional because they denied injured citizens a remedy guaranteed under the Constitution for the State of Oregon.  New limits were passed by the legislature, and they will likely be argued also as unconstitutional.

One more thing:  this act allows claims against "subdivisions" of the government, like Cities, Counties, Special Districts, Ports, or any other government entity.

The State of Washington

The State of Washington also has a tort claims process.  You must complete a form, and provide specific information about the facts of your claim, your injuries, your medical care, and your lost wages.  You must provide this information to the Office of Risk Management within the time you have to file the lawsuit against the agency, and you must give the Office of Risk Management sixty days to look over the materials.  You can only file a lawsuit after the sixty day time period has elapsed.  After the sixty days, you may file the claim if you cannot resolve your dispute with the State of Washington.

The Federal Tort Claims Act

The Federal Tort Claims Act requires that you file a claim with the federal agency that caused your injury.  The claim has to be filed with a Standard 95 Form, and you must file it within two years of the date of your injury.  You have to give the federal agency six months to consider the claim.  If it rejects the claim, or if the six months expires without any action, then you may file your claim. 

Just like the state tort claims act, there are limitations on the kinds of cases you may bring, and possibly, the amounts you may recover.

We have handled tort claims against many cities, counties, the States of Washington and Oregon, and the federal government.  If you have a question about a claim against the government, call us at 503 325 8600. We help people with issues like this all the time.

Even though you are not feeling well, things are hectic after you have been injured in an Oregon auto collision.  Here is a list of the people you may hear from in the days following the collision:

1.  Your Insurance Company

Your insurance company will provide personal injury protection coverage, or PIP, to cover medical expenses, and wage loss.  You will receive a claims form, and some releases.  You should fill these out so you can get medical care, and if you qualify, wage loss benefits.  You may also have to give a statement.  Your insurance policy probably includes a provision that requires you to cooperate with your insurance company, so you may have to give a statement.  However, realize that some how, some way, this statement could end up int he hands of a defense attorney.

You may also hear from an adjuster from your company for property damage claims.  This depends on the type of coverage you have on your policy.  This adjuster may send out a property damage appraiser to look at your car.  You may even hear from the wrecking yard or body shop as well.

2.  The Other Drivers' Insurance Company

You will hear from a bodily injury adjuster from the other driver's insurance company.  The adjuster's job is to resolve your claim as quickly and cheaply as possible.  Some adjusters will try to resolve the case even before you have completed medical care.  You do not need to speak with this person, sign any releases for medical records, or provide a statement.  We generally advise that you not give any information to this adjuster.

Now there is the property damage adjuster, also for the other driver's insurance company.  If you want your car fixed, a rental, or settlement of your total loss claim, then you are probably going to have to deal with this adjuster.  However, avoid talking about the facts of the collision, or your injuries. 

3.  The DMV

The Department of Motor Vehicles, or DMV will not call you, but if the collision caused injury or property damage beyond $1,500.00, then you will have to file a DMV accident report.  This is required to prove that you had insurance.  You are supposed to file this report within 72 hours of the collision, but DMV realizes that you may not be up to it, so will allow you to do this "as soon as possible."  You should not put this off too long, however, to avoid receiving a notice of suspension.

You do not have to provide the DMV report to anyone, it is confidential.

4.  Lawyers

Many attorneys will order a copy of your police report, if there is one, and write a letter soliciting their services.  Some of the letters we have seen state that the other driver "may" have been intoxicated.  They may also have been from Mars.  This is just an attempt to get a call from you.  Be wary of this kind of advertising.  Some of it may provide good information, but some not.

If you can keep track of phone calls with notes, and follow up any discussions in writing, that is a great help.   Copying anything you send out is also a good idea.

If you have questions about your Oregon auto injury claim, give us a call at 503 325 8600.  We help people with these issues every day.

The Basics

Every state has its own insurance laws, often referred to as the insurance code.  Oregon law requires insurers doing business in Oregon to provide basic levels of coverage.  One of these coverages is known as "Personal Injury Protection," or "PIP" for short.  Here is a run down of the menu of benefits in your Oregon PIP coverage if you are involved in a collision.

It's "No Fault."

This means that the benefits are available regardless of who causes the collision. Even if you are at fault in causing an auto collision, you are entitled to PIP coverage. If another driver causes the collision, you are covered, but in many cases, your insurer is entitled to be reimbursed for the benefit it provides.

To be covered, you must be an "insured." This includes not only the person named on the policy, but also a driver who has permission to drive the vehicle. Passengers are covered, and in some cases, a pedestrian struck by an Oregon insured vehicle may have PIP coverage from the Oregon insured car.

Medical Insurance

Medical insurance must cover $15,000.00 for related and necessary medical care incurred within two years of the date of injury. Insurers may provide additional amounts of medical coverage.The statute borrows from Oregon's workers compensation medical fee payment schedule, so that all medical expenses are paid as if the treatment were for an on-the-job injury. This means there are usually no co-pays or deductibles with covered medical treatment.

The insurer must deny benefits within 60 calendar days after receiving a billing request from a medical provider. The medical provider must respond to written requests from the insurer within ten days during the first 50 calendar days after the injury.

The Insurer Can Deny Medical Coverage, But You Can Appeal

The insurer may question whether ongoing treatment is necessary, or related to the original injury. In these cases, the insurer can require that the insured attend an "independent medical examination." The examiners are not often true the independent, and may find that ongoing treatment is excessive or not related to the injuries caused in the motor vehicle collision. If the independent medical examiner finds that treatment is no longer necessary, the insurer can deny further treatment for coverage. However, the insured can appeal this denial by requesting arbitration, or filing a lawsuit directly against the insurer. In certain cases, the injured party may recover attorney fees if it prevails in court.

Sometimes, it may make better sense not to attend an independent medical examination. This is a decision that must be made on a case-by-case basis.

Other Medical Coverage

In serious injury claims, the personal injury protection or PIP medical coverage is often exhausted within days after the collision. In some cases, there being be another auto policy that will take over payment of medical expenses. This happens when there is more than one vehicle insured in a family household.

When the maximum coverage for PIP medical benefits is paid out, this is known as "exhaustion" of benefits. The next coverage in line to pay medical expenses is private health coverage, including any government-sponsored health plans like Medicare, Medicaid, or the Oregon Health Plan. The Oregon Health Plan also includes Coordinated Care Organizations, which behave like a Managed Care Organization.

Paying Back PIP or Other Health Insurers

If another driver caused your injury, your personal injury protection carrier is in the same legal position as you. You have suffered a personal loss because he suffered personal injury. Your insurer was forced to pay benefits, and it suffered a business loss. The Oregon personal injury protection statute allows your insurer to recover what it paid in medical or disability benefits. There are several ways your personal injury protection insurer can recover the benefits it paid. This is something you should pay attention to as he moved forward with the claim.

The same is true for other medical coverage including any private health plan, Medicare, Medicaid, Oregon Health Plan, or Coordinated Care Organizations. If you have a private health plan, the plan includes a provision that conditions payment for medical benefits on your promise to repay your health plan out of any settlement or recovery make against the at fault insurer. This is important to know because private health plans have the right to sue for recovery of benefits paid, and can get attorney fees in addition to the health benefits paid.

Government-sponsored health care plans rely on statutes that require you to report your claim against an at fault party. You then must report the settlement of any claim. After reporting claim settlement, the agency or a government contractor will contact you to make a demand for reimbursement. This is something not to ignore. For example, if Medicare is not reimbursed, it can sue you, your attorney, and the insurance company for triple the amount of the accident related medical benefits provided!  There are also potential hefty fines. Do not ignore Medicare or any other government sponsored health plan.

Disability Benefits

Again, regardless of who caused the collision, if your insured under PIP coverage, you have a potential claim for wage replacement benefits, also known as "disability benefits." To qualify for benefits, you must prove that you were disabled from your work for at least fourteen consecutive days. The best proof of disability is verification from a treating physician. Many of the insurers will provide forms to the physician to complete and return to the insurance company. If you qualify for disability benefits, the insurer must provide 70% of your average weekly wage. There is a $3,000.00 On disability benefits, meaning that regardless of the extent of your lost income, you can recover no more than $3,000.00 in disability benefits for any given month.These benefits are not limited to the first two years after the injury, but instead run for a period of "52 weeks in the aggregate."

Essential Services: Managing a Household

If someone injured in a collision is not working outside of the house, and disability continues for 14 consecutive days, there is coverage for "essential services."  This includes the value of housekeeping, and is limited to $30.00 per day, with a maximum benefit period of 52 weeks.

Funeral Benefits

If the collision causes a fatality, the estate is entitled to recover $5,000.00 in funeral expenses incurred within one year after the date of the collision.  In cases involving passengers or innocent drivers, there may be a wrongful death claim, and the personal protection carrier may request reimbursement for this benefit as well.

Child Care

If the injured person is a parent of a child, and is hospitalized for at least 24 hours, the personal injury protection coverage allows a $25 per day benefit for child care, with the benefit payment beginning after the initial 24 hours of hospitalization, and to continue as long as the injured party is unable to return to work or perform essential services that they would have done even if they were not paid. The overall limit of benefits is $750.00.

PIP Coverage and the Underinsured Motorist Claim

If you suffer a serious injury, and the available coverage from the other driver's insurer is insufficient to compensate you for your injury, you may have an underinsured motorist claim. This coverage is also available if the other driver was uninsured. Recent changes in the law allow you to make a claim for compensation up to the amount of your uninsured/underinsured motorist coverage in addition to the amount of coverage and the at fault party's liability policy.

However, your insurer is entitled to a credit for the personal injury protection benefits it provided for your medical care, disability, or any other personal injury protection benefits. There are exceptions to this rule depending upon the amount of damage you can establish in an underinsured/uninsured motorist claim.

You Can Still Claim Actual Expenses Incurred

The amount he received from your personal injury protection carrier does not limit the claims you can assert against the at fault driver for your medical expenses or wage loss. For example, a physician may charge $150.00 for a doctor visit. The personal injury protection carrier may enjoy a discount of $50.00, and have to pay only $100.00 of the medical expense. Nonetheless, the medical expense incurred is $150.00, and you can make a claim for that amount if you end up filing a case in court.

The same is true for the wage loss or disability benefit. The personal injury protection carrier only pay 70% of your average weekly wage, but in reality, you may have lost more than 70% of your average weekly wage, and may have future lost earnings as well. Nothing the personal injury protection carrier pays you limit your ability to make a claim for the true loss of income, including future lost income, or future lost earning capacity.

Questions

Personal Injury Protection benefits and reimbursement of those benefits in serious injury claims can make for some issues, so if you have questions, contact us. We handle these issues every day.

 

The Problem:  Future Medical Expenses in the Oregon Auto Injury Claim

The cost of medical care has almost doubled in the last couple of decades, and it’s fair to assume the trend will continue upward.  Our Oregon and Washington auto injury clients face special challenges when their injuries require future medical care.  This article provides a summary of how we handle claims for future medical expenses.

First, Some Definitions

First a little background.  Both Washington and Oregon split the kinds of compensation you can claim into two different categories:  What is objective, and what is not. 

In Oregon and Washington, medical expenses are in the objective category, because the medical bill is a specific amount.  Everyone will agree on the amount of the medical bill, but they may not agree that it is part of the case.  More on that below.

In Oregon, medical expenses fall into the “economic” damage category.  In Washington, medical bills are a form of “special” damage.  These are just two different labels for the same thing.

How You Prove Medical Expenses

First, you need to show that the medical treatment reflected in the medical bill was necessary to treat injuries related to the collision.  Some medical expenses are obvious, like ambulance and emergency room bills.  Others are not.  If a case goes to trial, a medical expert’s testimony is needed to prove that the medical expenses are related to the auto collision injuries.

You must also prove that the medical treatment reflected in the medical bill is a reasonable charge.  This is usually a formality, but some insurance companies may attack the amount of the medical expense as being unreasonable.

How Future Medical Expenses Are Different

The rules for future and past medical expense are the same but proving that something will happen in the future is always a different challenge.

To prove future medical expense, a medical expert needs to explain what care will be required, and why.  But you will also need someone to talk about how much the care is going to cost over the long run.  When our client is facing life long medical care needs, we work with life care planners.  A life care planner is a special expert that reviews medical records, confers with medical providers, and our client, to create a life care plan.  The life care plan that is created sets out a schedule of all the medical care our client will need throughout their life.

Just like any issue in a serious Oregon personal injury case, there is no guarantee that an insurance carrier or defense attorney is going to accept a life care planner’s report.

Other Claims Related to Future Medical Care

In many cases, a doctor will not be able to say that our client will probably need future medical care but can say there is an increased risk of developing future problems, or that there is a very good chance that some kind if treatment, like surgery, is in our client’s future.

Oregon law allows us to argue for non-economic damages where your injuries put you at greater risk for developing future problems that could require more medical care.  Some people say that this is compensation for “fear of future disease.”  In plain English, someone having to deal with the possibility that their injury is going to come back to haunt them is entitled to compensation for living with that real possibility.

When The Settlement Does Not Cover Future Medical Care

We can prove all the future medical treatment needs possible for our client, but at the end of the day, there is a limited amount of liability insurance coverage available for every claim.  Sometimes, the available insurance will cover future medical expenses, but often, it does not.  When faced with this situation, the challenge shifts to doing everything we can to make sure our client has access to medical care after their case is completed.  That involves negotiating with health care plans or structuring the settlement so our client can get the medical care they need.

Questions?

We help people with serious injury cases all the time.  If you have questions, contact us.  At the very least, we can help you know where you stand.

The issue of whether there is sufficient insurance to cover someone's losses in an Oregon auto injury claim is becoming a more common concern. For a long time, Oregon law has required a motorist to carry a minimum of $25,000.00 in liability coverage. We refer to this as the "policy limits." This is coverage for any liability or damages caused for careless behavior.

If you were injured by a careless driver with minimal policy limits, the $25,000.00 coverage must compensate you for your lost wages, your medical expenses, and compensation for the loss of your health, often referred to as "non--economic damages", or compensation for pain, suffering, and loss of activities. We like to refer to this compensation as compensation for the loss of your health.

In many cases, my clients will suffer serious injuries that required extensive medical care, and caused significant disability. As a result, the medical expenses and lost wages alone will exceed the available insurance policy proceeds from the responsible party.

The first option we explore is an underinsured motorist claim. Uninsured motorist coverage exists on every Oregon auto insurance policy, and is designed to insure you against the uninsured motorist, or the "underinsured" motorist. Your uninsured motorist coverage is the same as the amount of liability coverage you purchased from your insurance company.

An uninsured motorist claim exists when you are injured by a driver with no insurance coverage. An underinsured motorist claim is a claim against your insurance company, but is only available to the extent that your "uninsured motorist" coverage exceeds the liability coverage of the other party. This is why we strongly recommend that you review your insurance policy to make sure you have adequate protection.

If your uninsured motorist coverage is the same as the responsible party's liability coverage, then generally, you will not have an uninsured motorist claim. In these cases, we will work with medical creditors, as well as your insurance company to negotiate any outstanding liens or medical bills to maximize your recovery. However, you may be faced with a serious injury without adequate compensation.

To learn more about whether there is enough insurance compensate you for your injury, request are free book, or give us a call at 503-325-8600.

It’s A Common Question

We consult with people injured in auto collisions all the time.  There are common questions.  What are my rights?  What should I sign, or not sign?  Who are all these people calling me?  These are questions we can answer, but one question we get that is not so easy is:

What is my case worth?

Oregon Injury Case Value Opinions Require Research

I can provide no opinion on the value of an Oregon auto injury claim unless I have all the information I can obtain to evaluate the claim. The first question is whether the other driver is legally responsible for causing your injuries. Many cases are straightforward. For example, a rear end collision is often the fault of the striking vehicle. However, unless you can establish that the other driver’s careless behavior caused the collision and some injury, you do not even get to a claim for damages.

The Losses You Can Recover in An Oregon Auto Injury Claim

To know the value of a claim, you need to know what you can claim.

There are two categories of “damages” or compensation you can claim if injured in an Oregon auto collision. The first is known as “economic” loss or damage. These are objectively verifiable like medical expenses or lost income. You may claim already incurred medical expenses and lost income. In serious injury claims, there may be a claim for future lost earnings or lost earning capacity and need for future medical treatment.

Although every case is different, some common themes govern our evaluation of claim value and help us advise our client how to move forward with their Oregon auto injury claim.

How Insurance Adjusters Think

Insurance carriers rely heavily on pieces of information they can use to compare one case to another. Many insurers use database programs that allow input of things like diagnostic codes, billing codes, and the damage to your car. Some of these items are known as “drivers.” Insurance adjusters evaluating an Oregon auto injury claim do not want to hear how the injury has affected you on a real-life level. This is because everyone is different, and that is not something that can be fed into a computer database.

Still, some hard facts impact the value of an Oregon auto injury claim. Here are a few examples.

The Collision

How the collision occurred is key to determining not only who was legally responsible, but whether the collision could have caused injury.

Generally, the more severe the impact, the more severe the injury. However, a serious injury can occur in a “low-speed” collision, and sometimes our client is fortunate enough to escape serious injury in a high-speed collision. There is not always a strong relationship between the damage to your car or the speed of impact and the resulting injury. But insurance adjusters and defense attorneys have a lot less room to argue that someone was not injured in high-speed collision with significant damage to your car. Fair or not the collision’s severity is a factor.

Medical Evidence: The Insurance Adjuster’s Focus

Medical evidence is probably the most important factor for insurance adjusters and defense attorneys in evaluating Oregon auto injury case value. This is because medical records often contain information that adjusters can compare one case to another (see above). There are other clues in the medical records that help someone injured in an Oregon auto collision prove their claim.

Medical Evidence: Timing of Treatment

One factor is the timing of treatment. A basic assumption is that someone injured in an auto collision will seek medical care when injured. We see clients who try to “tough it out,” maybe because they are determined not to be injured or are concerned about other family members injured in a collision. Sometimes, the adrenaline is literally flowing after an auto collision, and symptoms steadily creep to the surface after thing settle down. So, there is often a reasonable explanation for avoiding treatment immediately after collision.

But if somebody waits weeks or months before seeking medical care after an auto collision, insurance adjusters and defense attorneys will be suspicious, and find a physician who is more than happy, for significant fee, to provide an opinion there is no connection between the claimed injuries and the auto collision.

Medical Evidence: Chart Notes and Tests

Medical chart notes are another source of information that helps us evaluate claim value. Most chart notes include the following outline:

• Subjective Reports
• Objective Findings
• Diagnosis and Assessment
• Plan

Subjective reports are the patient’s report of symptoms to the physician. This is also called the “patient history.” This is as important as any part of a medical examination because it shows the physician the potential issues or injuries that may have occurred in the auto collision.

For example, if somebody reports of neck pain to a physician after an auto collision, the doctor may want to know if the pain is radiating into the arms or is only in the neck and upper back. Radiating pain into the arms may indicate a more serious injury like a nerve impingement or herniated disc. Other information like the onset of symptoms, aggravating factors, and the intensity of symptoms also helps a physician form a diagnosis.

Objective findings are those things that a physician can observe without a patient’s input. A fractured bone on an x-ray is an objective finding. The patient doesn’t need to be in the room when a radiologist views and x-ray to diagnose a fracture. Physicians can also perform clinical tests in the office that if positive, are objective findings. This is common with orthopedists performing an examination for damage to the knee joint like a torn meniscus or anterior cruciate ligament tear.

After obtaining a history, and performing an examination, the physician may further investigate with other testing like an MRI or x-ray. Once your doctor has all this information, the physician makes a diagnosis, and puts together a treatment plan.

We will review all this information in evaluating a case, including your response to the recommended treatment, and the treatment’s effectiveness.

Medical Evidence: Prognosis

The “prognosis” is the “forecast of the course of the injury or ailment.” What will the future be like for you?

Often, auto collision injuries cause only a temporary loss of health. The prognosis is good, and there is no ongoing impairment from the injury. However, all too often, injuries suffered in an auto collision because permanent impairment.

If a physician determines that an injury will cause a permanent change in our client’s health, our client may recover compensation not just for losing their health until the claim demand or jury trial, but for the rest of their life. Therefore, the compensation for our client’s loss of health covers a much greater chunk of time.

Injuries with permanent impairment may also require ongoing medical care, and we often work with life care planners to make sure that we have an accurate accounting of the cost of future medical care.

If an injury causes permanent disability, we often work with economists and vocational experts to determine the true loss of future income because of a life changing injury.

Real Life Evidence

This is the most overlooked but most important part of any serious injury claim because the real-life impact of an injury is what it means to our client. Insurance adjusters do not have a place to enter this data into their claims evaluation software, but jurors will want to know the day-to-day impact a serious life changing injury causes. Often, the most powerful witnesses in an injury lawsuit are our client’s friends, co-workers and relatives because they know the real-life impact and injury can cause.

Questions

If you have an Oregon injury claim, and have questions, contact us. We help injured Oregonians every day.