Oregon is one of at least 16 states that lets companies selling auto insurance limit payouts to $25,000 for each injured passenger related to at-fault drivers in crashes.
The so-called "family exclusion" can cap coverage to $25,000 even when a driver carries a liability policy of $100,000 or more.
"If you're at fault in an accident and a family member is hurt really, really bad, if you've got $70,000 in medical bills—you're just...out of luck," says Neil Jackson, a Portland-based lawyer who estimates he has handled at least a dozen family-exclusion cases in his 30-year career.
Jackson and the Oregon Trial Lawyers Association are working with state legislators to develop a bill to eliminate the exclusions.
Insurance companies say they need the $25,000 family-exclusion limit because of the danger that relatives may collude to seek big "pain and suffering" rewards from insurers beyond their actual medical bills.
"It's just not a good thing for society—for family members to be making those kind of claims against one another," says Jeff Aeschliman, spokesman for State Farm Pacific Northwest.
Exclusions aren't typically spelled out on the one-page summary of benefits that policyholders most commonly reference. And if agents don't make customers aware of the exclusions, it's hard to imagine most people hopscotching through the jargon of 20-plus-page policies to learn when their family members aren't fully covered.
The limits rarely come into play because all Oregon drivers must carry $15,000 in personal injury protection or the other driver may be at fault in a crash, says Ron Fredrickson, manager of the Oregon Insurance Division's consumer advocacy unit. But when the exclusion is invoked by insurance companies, it tends to limit coverage on the most catastrophic accidents.
Take Tosha Mowry's case: In October 2005, she was 26 weeks pregnant. Mowry's boyfriend, Mario Urzua, fell asleep driving her 2001 Lexus sedan near Warm Springs on U.S. 26. Urzua drove across the barrier, severely injuring another motorist and Mowry. Mowry was hospitalized with injuries to her head and uterus as well as a fractured clavicle. Her unborn baby died the following day.
Mowry carried a "100/300" policy with Farmers Insurance—meaning she believed she'd get up to $100,000 per injured person, and up to $300,000 per crash involving her car.
Farmers said it would pay Mowry $25,000 for herself, and $25,000 for her unborn child. Her initial medical bills totaled about $40,000 but her attorney says future medical treatments and compensation for her pain and suffering pushes her client's expenses well past Farmers' offer.
"This is a classic example of a bait-and-switch," says Hala Gores, the Portland attorney preparing a lawsuit on Mowry's behalf. "Farmers paid the $100,000 maximum to the other driver...but they're only paying $25,000 for Mowry's own baby? It's just outrageous that they can do this."
Farmers had no immediate comment.
No one has estimates on exactly how much the exclusions save insurers annually. But David Snyder, vice president and assistant general counsel of the American Insurance Association, says they're a way "to reduce costs to make basic coverage more affordable for more consumers."
He says premiums will rise for everybody if the family exclusions are eliminated, though Oregon Insurance Division's Fredrickson predicts a rise would be small "because there aren't that many cases out there that are big and bad."
Nonetheless, Jackson expects insurers to try to kill any bill targeting exclusions.
"This law is just a dinosaur,'' Jackson says. "It's an anachronistic clause, and just doesn't belong there anymore."