USAA and Denial of PIP Benefits

Posted by Scott Edwards | Jun 13, 2019 | 0 Comments

Being a personal injury attorney, we can often see patterns in how insurance companies adjust and resolve claims. Sometimes, for example, the pendulum swings toward settling claims and saving on defense costs (meaning, the insurance company might be okay paying a little bit more to settle a claim if it means that it doesn't have to incur the expenses of defending a lawsuit). Other times, the pendulum swings toward litigation (meaning the insurance company offers low amounts to settle a claim knowing that they will spend more on defending the lawsuits).

This second tactic—what we often call deny and defend—can wreak havoc on the insurance company's duty to follow Washington's laws governing the insurance company's behavior when it comes to the company's claims settlement practices. These laws, called the Insurance Fair Conduct Act, or IFCA, require the insurance company to treat its insured's interests equal to its own interests and that it only deny claims after having a reasonable basis to do so. Though Oregon's laws are somewhat different when it comes to how these tactics may be countered, Oregon state laws also prevent this type of conduct.

Despite these laws, we have seen a huge swing of the pendulum when it comes to the way that USAA handles personal injury protection or “PIP” claims. We have repeatedly seen USAA deny our clients' PIP claims—leaving our clients' medical bills unpaid. Almost every time this happened, it was after USAA sent the medical bills to a third-party company called “Auto Injury Solutions”. USAA sends our clients' medical records and bills to doctors and chiropractors in Florida (or other out-of-area locations), who look at the records, and without ever seeing our client, determine whether the treatment was reasonable and necessary and whether the medical record itself is sufficiently detailed to permit payment. As you might suspect, these doctors routinely determine that our clients' treatment was unreasonable or that their medical providers did not sufficiently document their medical records.

These types of claims denials may violate USAA's duties to its insureds in Washington and Oregon State which, as alluded to above, both have protections against this type of overly aggressive claims handling. We, along with many other personal injury attorney firms in Washington, Oregon, and no doubt throughout the country, are working on strategies and efforts to curb this type of behavior and to bring it to the Court's attention.

If you are a victim of USAA's policy and are having your medical bills denied, we'd like to know about it. We'd like to evaluate whether USAA's approach to your claims may justify adding you to our efforts to bring USAA's claim handling in line with Washington's or Oregon's laws.

About the Author

Scott Edwards

Scott Edwards is a partner at Schauermann Thayer Jacobs Staples & Edwards law firm. Scott is licensed in both Oregon and Washington, and has been practicing law since 2008. Though Scott started his career working for insurance companies, he now focuses his practice on personal injury, auto accident, biking accident, and insurance cases. In his free time, Scott enjoys spending time pedaling around the streets of Vancouver, Washington and Portland, Oregon on his bicycle.


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