Insurance Policies Generally

ORS 742.520
Personal injury protection benefits for motor vehicle liability policies

  • applicability


(1)

Every motor vehicle liability policy issued for delivery in this state that covers any private passenger motor vehicle shall provide personal injury protection benefits to the person insured thereunder, members of that person’s family residing in the same household, children not related to the insured by blood, marriage or adoption who are residing in the same household as the insured and being reared as the insured’s own, passengers occupying the insured motor vehicle and pedestrians struck by the insured motor vehicle.

(2)

Personal injury protection benefits apply to a person’s injury or death resulting:

(a)

In the case of the person insured under the policy and members of that person’s family residing in the same household, from the use, occupancy or maintenance of any motor vehicle, except the following vehicles:

(A)

A motor vehicle, including a motorcycle or moped, that is owned or furnished or available for regular use by any of such persons and that is not described in the policy;

(B)

A motorcycle or moped which is not owned by any of such persons, but this exclusion applies only when the injury or death results from such person’s operating or riding upon the motorcycle or moped; and

(C)

A motor vehicle not included in subparagraph (A) or (B) of this paragraph and not a private passenger motor vehicle. However, this exclusion applies only when the injury or death results from such person’s operating or occupying the motor vehicle.

(b)

In the case of a passenger occupying or a pedestrian struck by the insured motor vehicle, from the use, occupancy or maintenance of the vehicle.

(3)

Personal injury protection benefits consist of payments for expenses, loss of income and loss of essential services as provided in ORS 742.524 (Contents of personal injury protection benefits).

(4)

An insurer shall pay all personal injury protection benefits promptly after proof of loss has been submitted to the insurer.

(5)

The potential existence of a cause of action in tort does not relieve an insurer from the duty to pay personal injury protection benefits.

(6)

Disputes between insurers and beneficiaries about the amount of personal injury protection benefits, or about the denial of personal injury protection benefits, shall be decided by arbitration if mutually agreed to at the time of the dispute. Arbitration under this subsection shall take place as described in ORS 742.521 (Conditions applicable to arbitration proceedings).

(7)

An insurer:

(a)

May not enter into or renew any contract that provides, or has the effect of providing, managed care services to beneficiaries.

(b)

May enter into or renew any contract that provides evaluation services for beneficiaries. [Formerly 743.800; 1991 c.768 §6; 1993 c.282 §1; 1993 c.596 §39; 1995 c.658 §114; 1997 c.344 §§1,2; 1997 c.808 §§3,4; 1999 c.434 §1; 2003 c.813 §1; 2005 c.465 §3; 2007 c.328 §8]

(formerly 743.800)

Notes of Decisions

Insurance policy clause required by this section, providing for payment of 70 percent of injured person's lost wages during period of disability, was inapplicable where injured person was killed instantaneously, because there was no period of "disability" within meaning of policy. Perez v. State Farm Mutual Auto Ins. Co., 43 Or App 19, 602 P2d 284 (1979), aff'd 289 Or 295, 613 P2d 23 (1980)

Where liability policy issued to plaintiff's father covered private passenger vehicle registered to father, fact that plaintiff was injured riding motorcycle did not disqualify him from PIP coverage. Garrow v. Pennsylvania Gen. Ins. Co., 40 Or App 23, 594 P2d 415 (1979), aff'd 288 Or 215, 603 P2d 1175 (1979)

Where, at time of accident, insured father's married son and his wife and child were living in father's house and paying $100 per month room and board, son was member of father's family, residing in father's household as required for coverage under this section. Garrow v. Pennsylvania Gen. Ins. Co., 40 Or App 23, 594 P2d 415 (1979), aff'd 288 Or 215, 603 P2d 1175 (1979)

Language of this section and [former] ORS 743.805 indicates that legislature was aware of family exclusion provision and chose to regulate it only to limited extent. State Farm v. Baughman, 57 Or App 576, 646 P2d 102 (1982)

Under definitions of "pedestrian" and "occupying" of this section, defendant who was ejected from car, rendered immobile and struck by plaintiff's insured, was "pedestrian." State Farm Ins. v. Berg, 70 Or App 410, 689 P2d 959 (1984), Sup Ct review denied

Where passenger was occupying motor vehicle insured as temporary substitute vehicle in driver's policy, personal injury protection benefits afforded to passenger under driver's liability policy while passenger was riding in her own vehicle were primary insurance, while personal injury protection benefits afforded to passenger under her own broad form named operator policy were excess insurance. Utah Home Fire Ins. Co. v. Colonial Ins. Co., 300 Or 564, 715 P2d 1112 (1986)

ORS 12.155, which requires person making advance payment before determining tort liability to give written notice of when applicable statute of limitations will run, is not applicable to Personal Injury Protection payments made under this section. Smith v. Riker, 88 Or App 579, 746 P2d 247 (1987), Sup Ct review denied

Breach of good faith duty to pre-authorize treatment is denial of benefits subject to mandatory arbitration provision. Eggiman v. Mid-Century Insurance Co., 134 Or App 381, 895 P2d 333 (1995)

Injury results from use of motor vehicle if injury is direct or indirect consequence or effect of motor vehicle use. Carrigan v. State Farm Mutual Automobile Ins. Co., 326 Or 97, 949 P2d 705 (1997)

Any person permitted by insured to use insured's motor vehicle is entitled to personal injury protection benefits unless person is specifically excluded from such protection by law. Sheptow v. Geico General Insurance Co., 246 Or App 18, 265 P3d 4 (2011), Sup Ct review denied

Atty. Gen. Opinions

Use of PIP benefits for uninsured pedestrian eligible for medical assistance and covered under Motor Vehicle Accident Fund, (1982) Vol. 43, p 1

Law Review Citations

31 WLR 737 (1995)

§§ 742.520 to 742.542

(formerly 743.800 to 743.835)

Notes of Decisions

Nothing in PIP statutes prohibits plaintiff from pleading and proving all special damages in a civil action, even though plaintiff has received PIP benefits from his insurer. Koberstein v. Sierra Glass, 65 Or App 409, 671 P2d 1190 (1983), as modified by 66 Or App 883, 675 P2d 1126 (1984), Sup Ct review denied

PIP endorsement which offsets PIP payments against policy's liability limits does not contravene PIP scheme of these statutes. Edwards v. Bonneville Automobile Insurance Co., 68 Or App 863, 683 P2d 142 (1984), aff'd 299 Or 119, 699 P2d 670 (1985)


Source

Last accessed
Jun. 26, 2021