Attorney Question

[Guest guest]

Hi All! I had an attorney question: I had a patient that was treated for a MVA several months ago. The person that caused the accident didn't have insurance. My patient (age 55) was driving his parents car (age ~75), but is not listed on the policy. Also, and I'm not sure if this is 100% true, the parents didn't want their son listed on the policy. The insurer has denied PIP benefits because he's not listed on the policy. We've called his insurance and asked if he's entitled to have his medical paid for and the adjuster said "no". Is that correct? If not, how do I get them to pay for it, since the carrier is not cooperating? Is he entitled to pain and suffering?

Thanks, Cluen, DC

[Guest guest]

Doctors, To answer Dr. Cluen's questions, I'll deal with them in turn:1) "Does Parents' PIP cover son?" Son needs to check the policy at issue, but here's a part of the statutory minimum an Oregon policy must include, though it's of course not clear from the facts this was an Oregon-issued policy: 742.520

Personal injury protection benefits for motor vehicle liability policies;

applicability.

(1) Every motor vehicle liability policy issued for delivery in this state that

covers any private passenger motor vehicle shall provide personal injury

protection benefits to the person insured thereunder, members of that person’s

family residing in the same household, children not related to the insured by

blood, marriage or adoption who are residing in the same household as the

insured and being reared as the insured’s own, passengers occupying the insured

motor vehicle and pedestrians struck by the insured motor vehicle.So, if son lives with parents, he's definitely covered by PIP. If he doesn't (and you're sure he isn't named on the policy) his OWN auto policy (if he has one on another car) is secondary. After that, his personal medical insurance is the backup. If he doesn't have personal medical insurance, the bill falls to Son personally (normally it would go to at-fault's PIP at this point, but of course at-fault driver is uninsured). 2) "How do I get them to pay for it?" Request a letter explaining why coverage is being denied. As ever, though, the only option beyond peaceful persuasion is the threat or reality of legal action. 3) "Is he entitled to pain and suffering?" Sure, by being injured by someone else's carelessness, he's definitely picked up what are called "non-economic damages," but the trick will be getting anyone to pay for them. PIP NEVER pays for non-economic damages. As we all know, they barely pay for the particular economic damages that the victim attempted to "insure" him or herself against when they paid premiums every month. The only parties who might pay for non-economic damages are a) the at-fault driver, and the UIM policy of Parents. (A) is unlikely, since uninsured driver probably doesn't have the assets necessary to justify pursuing a lawsuit, and is incredibly unlikely to offer to pay anything at all without a judgment. ( is unlikely, since son may not be covered under this policy, but a good lawyer needs to examine that policy to make sure there's no chance of coverage. Either way, it will be a while before you're paid under either of these routes. Hope that helps!Respectfully,Ben On Nov 11, 2010, at 2:46 PM, Cluen wrote:Hi All! I had an attorney question: I had a patient that was treated for a MVA several months ago. The person that caused the accident didn't have insurance. My patient (age 55) was driving his parents car (age ~75), but is not listed on the policy. Also, and I'm not sure if this is 100% true, the parents didn't want their son listed on the policy. The insurer has denied PIP benefits because he's not listed on the policy. We've called his insurance and asked if he's entitled to have his medical paid for and the adjuster said "no". Is that correct? If not, how do I get them to pay for it, since the carrier is not cooperating? Is he entitled to pain and suffering? Thanks, Cluen, DC --Ben , Attorney at Lawben@...Law Office of Dr. DeShaw, Esq., P.C.Portland OfficeWorld Trade Center121 SW Salmon, Suite 1020Portland, OR 97204(503) 227-1233Seattle OfficeColumbia Center701 5th Ave., Suite 4200Seattle, WA 98104www.deshawlaw.com(866) THE-FIRM