Oregon's Auto Insurance Claim Denials: Understanding Your Rights And Challenges

Oregon has a mandatory car insurance law that requires all drivers to have a minimum level of insurance for their vehicles. This includes bodily injury and property damage liability, personal injury protection (PIP), and uninsured motorist coverage. If your auto insurance claim has been denied in Oregon, it's important to understand your rights and the steps you can take to challenge the denial. Oregon law states that insurance companies must act in good faith and provide fair and reasonable service to their customers. If you believe your insurer has acted in bad faith, you can take legal action to obtain financial compensation. It is recommended to document all communication with your insurance company and seek legal guidance if you encounter difficulties with your claim.

Oregon insurance bad faith

In Oregon, insurance policies are contracts, and legal rules come into play when filing an insurance claim. Insurance companies and their employees are required to act fairly and reasonably and follow Oregon laws and regulations. They must conduct thorough and unbiased investigations and assessments of losses and pay or deny claims in a timely manner, complying with the policy contract and applicable laws.

If an insurance company acts in bad faith, it undermines the fundamental purpose of insurance, which is to provide financial protection and peace of mind to policyholders in times of need. Policyholders can experience denied claims, delayed payments, and unfair treatment as a result of insurance bad faith.

Oregon's Unfair Claims Settlement Practices Act, found in ORS 746.230, outlines unfair claim settlement practices that are prohibited. These include misrepresenting facts or policy provisions, failing to act promptly on communications relating to claims, refusing to pay claims without a reasonable investigation, and failing to affirm or deny coverage within a reasonable time.

If you believe your insurance company is acting in bad faith, it is essential to take proactive steps to protect your rights. This includes documenting all communication with the insurance company, keeping records of expenses and treatments, and familiarizing yourself with the terms and conditions of your insurance policy. Seeking legal guidance from an experienced attorney is also recommended.

Unfair claim settlement practices

In Oregon, unfair claim settlement practices are outlined in the Unfair Claims Settlement Practices Act (ORS 746.230). This act prohibits insurers from engaging in unfair practices when settling claims. Here are some examples of what constitutes an unfair claim settlement practice:

• Misrepresenting facts or policy provisions when settling claims.
• Failing to acknowledge and act promptly on communications relating to claims.
• Refusing to pay claims without conducting a reasonable investigation based on all available information.
• Failing to affirm or deny coverage of claims within a reasonable time after receiving completed proof of loss statements.
• Not attempting, in good faith, to settle claims promptly and equitably when liability is reasonably clear.
• Compelling claimants to initiate litigation by offering substantially less than what is ultimately recovered.
• Attempting to settle claims for less than what a reasonable person would believe they are entitled to.
• Failing to inform insureds or beneficiaries, upon request, of the coverage under which payment has been made after a claim has been paid.
• Delaying investigation or payment of claims by requiring claimants to submit unnecessary paperwork.
• Failing to promptly settle claims under one coverage of a policy to influence settlements under other coverages.
• Failing to provide a clear explanation for the denial of a claim based on the insurance policy and applicable laws.

These practices are considered unfair as they go against the principle of acting in good faith, which is expected in the relationship between policyholders and insurance companies. Oregon has been working to address these issues and provide legal remedies for those affected by unfair claim settlement practices.

Personal Injury Protection (PIP)

In Oregon, drivers are required to carry a minimum of $15,000 in PIP coverage, which pays for crash-related medical expenses. PIP coverage has a minimum amount and a per-person maximum coverage limit. If the cost of necessary medical care exceeds the auto insurance policy's PIP limits, health insurance may cover further expenses. PIP often also provides payments for lost income, childcare, and funeral expenses related to the accident.

The purpose of PIP is to provide prompt payment for medical expenses and lost wages resulting from injuries sustained in a car accident. It is important to note that PIP is not the same as liability insurance. While PIP covers medical costs for the policyholder and anyone in their vehicle, regardless of fault, liability insurance covers medical costs for a third party if the policyholder is at fault.

Time frames and deadlines for claims

In Oregon, there are several time frames and deadlines to be aware of when it comes to insurance claims. Here are the key points to remember:

• Processing your claim: Your insurer must acknowledge the notification of your claim within 30 days of receiving it. They also have 30 days to provide you with the necessary claim forms, instructions, and assistance to help you comply with the policy conditions and their reasonable requirements.
• Communicating information to you: Your insurer must respond to all relevant communications from you within 30 days.
• Investigating your claim: Your insurer typically has 30 days to investigate your auto insurance claim, although this can vary by state. In Oregon, insurers have 45 days to complete their claim investigation from the receipt of the claim. This can be extended if the investigation cannot reasonably be completed within this time frame.
• Paying or denying your claim: The insurer must inform you if your claim is accepted or denied within 30 days of receiving a properly executed proof of loss. This must be done in writing and include a reference to the relevant policy provision if the claim is denied.
• Statute of limitations: Oregon's statute of limitations for car accident claims is as follows:
• Personal injury claim: two years.
• Property damage claim: six years.

It's important to note that these time frames and deadlines may be affected by various factors, such as the circumstances of the accident, the severity of injuries and property damage, the involvement of lawyers, and how quickly you filed the claim. Additionally, your insurer is required to be fair and reasonable and follow Oregon laws and regulations throughout the claims process.

Hiring professional help

If your auto insurance claim has been denied in Oregon, you may need to hire professional help to get a full and fair settlement. While you should not have to bring in outside help to receive what you are owed, insurance companies have experts, lawyers, and claim professionals protecting their interests, and you are entitled to the same. Depending on your situation, you may need to hire a public adjuster, a lawyer, or another type of expert.

If you hire an attorney to resolve an insurance claim dispute, try to hire them on a contingency (not hourly) fee basis and agree to advance litigation costs. Claim disputes are time-consuming, so paying by the hour can get expensive quickly. Ideally, arrange for one or two qualified attorneys to do an initial evaluation of your situation free of charge. Only hire an attorney who has represented insurance consumers in claim disputes and is a member in good standing of the Oregon Bar.

A qualified public adjuster cannot practice law or give legal advice, but they can value your losses, handle the day-to-day aspects of your claim, and negotiate a settlement on your behalf. Generally speaking, if you hire a public adjuster, you agree to pay them a percentage of the insurance benefits they recover on your behalf – not an hourly fee.

Before hiring professional help, it is recommended that you review the following publications:

• Questions to Ask Before Hiring a Public Adjuster
• Hiring an Attorney for an Insurance Claim
• What to Expect When You’re Suing an Insurance Company
• What’s UP with Insurance Class Action Lawsuits?
• Lawsuit Limitations in Insurance Policies: Protecting your legal rights at the one year anniversary
• Sample Attorney-Client Fee Agreement
• Bach Talk: In praise of contingency fees
• Making the Best Choice When Hiring a Public Adjuster
• Public Adjusters: The Inside Scoop
• Well Adjusted: Interviews with Public Adjuster
• Rebuilding 101: A Guide to the Reconstruction Process
• Guidelines For Reviewing Adjusters’ And Contractors’ Estimates

Frequently asked questions