Tuesday, January 12, 2010

If the doctor only knew...

A doctor recently called my office on behalf of my client and her patient. The doctor was upset that the patient’s insurance company was closing his claim after one year. She blamed my office for the fact that his PIP year was about to run. My staff tried to explain to the doctor that this was the law in Oregon and my office was not “closing his claim.” However, the doctor refused to let anyone else speak. Had my office been given a chance to explain, this is what we would have said [The patient’s and doctor’s names have been removed for privacy reasons]:
Dear Dr. ___

You called my office on December 9, 2009 regarding Mr.___. First and
foremost, it is a joy to see a doctor be such an advocate for her patient. That
seems to be increasingly rare nowadays. To that end, please be assured that you
and I are on the same team and we both want what is best for Mr. ___. Based on
what I learned, I’m not certain you understand Oregon’s insurance law. The
purpose of this letter is educate you on Oregon law as it pertains to motor
vehicle accidents.

Personal Injury Protection – Oregon Insurance

When a person is injured either occupying or otherwise using a motor
vehicle, the insurance for that vehicle covers the accident related medical
expenses for up to one year and a minimum of $15,000. Here, Mr. ____’s PIP claim
runs (by law) on December 13, 2009.

Neither I nor this firm “close” claims. That is what an insurance
company does. Regardless of how much treatment Mr. ___ needs, his PIP claim will
end on December 13, 2009.

Treatment after the PIP Year

Oftentimes, an injured person will need more than one year of
treatment. Oregon law states that after PIP is exhausted or the PIP year is
over, the injured party’s own health insurance is next in line. If a person does
not have health insurance, that person is responsible for the medical bills
until they reach a settlement or receive a judgment.

To help clients who fall into the latter category, namely no insurance
or high deductibles, I am willing to write letters of protection to the
providers (such as yourself). A letter of protection is an agreement wherein the
provider agrees to continue treating the injured person but to hold their
account open. In exchange for providing treatment, the attorney agrees to pay
the provider from the proceeds of the settlement or judgment before the injured
party receives any money. Fewer providers are accepting these types of letters

Mr. ___’s claim

As I understand it, you are recommending additional treatment for Mr.
__. As you now know, his PIP claim is nearly expired so his health insurance is
next in line. However, Mr. ___informs me that he has a high deductible that he
cannot afford.

At this point, I am offering to write a letter or protection for your
continued treatment of Mr. ___. What he needs is for you to bill him (but hold
his account open) up to his deductible for treatment you provide. After that,
his health insurance will pay for his accident related medical expenses.

If you have any questions or concerns, feel free to contact me
directly. Please read more blogs and articles on our website www.dwyerwilliamspotter.com.


Arne Cherkoss