If the pedestrian does not reside with a family member who has auto insurance, and the pedestrian does not have their own auto policy then the next obligated payer of medical expenses in line is the pedestrian’s health insurance. Or, if a PIP policy is applicable but the $15,000 benefit is exhausted, the health insurance is next in line. In this example, “health insurance” is meant to include privately obtained health insurance, health insurance through an employer, Oregon Health Plan, or Medicare.
Often, these health insurance carriers will initially deny payment on any medical expenses associated with an automobile accident. They do this because they are aware of the law that says they are not primary. They are aware that PIP typically comes first. However, if the appropriate documents are provided to the health insurance company indicating that there are no applicable PIP benefits, or they have been exhausted, then the health insurance carrier will general agree to pay.
What if there is no health insurance? Well, in that case, we finally look to the vehicle that caused this accident. The medical benefits under the PIP of the at-fault vehicle is responsible to pay PIP benefits if the above options are not available. This is unique to pedestrian accidents. For instance, if you were a passenger in an uninsured vehicle and you were hit by another car that was at fault, under no circumstances does the law allow you to seek the PIP benefits of the at fault driver. This is also true if you are on a motorcycle when hit by a bad driver. The PIP of the opposing vehicle can only extend to pedestrians, (bicyclists included), if the other options don’t apply. But remember, there is also a liability damages claim. This is different than a medical bill PIP claim, (which pays regardless of fault). Under the liability claim, an injured pedestrian can pursue all forms of provable damages, including medical expenses, (unless they have already been paid for by the PIP), wage loss, pain and suffering, and any other verifiable related damages. Settlement of these damages however, often comes at the end of a case, long after medical expenses have been incurred. So, it is very beneficial to access PIP medical and wage benefits before a case settles so that medical bills get paid in a timely fashion rather than be sent to collections waiting for a settlement that may not come for another year. Also, getting the PIP wage benefit early on can help the injured pedestrian with money to pay bills while waiting for the settlement.
In summary, a pedestrian has the same legal rights to pursue an injury claim and all damages against a negligent driver. Pedestrians also have additional opportunities to pursue PIP medical benefits and wage benefits.
