Contents of personal injury protection benefits
- deductibles
Source:
Section 742.524 — Contents of personal injury protection benefits; deductibles, https://www.oregonlegislature.gov/bills_laws/ors/ors742.html.
Notes of Decisions
Language of this section and [former] ORS 743.800 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 1022 (1982)
Where plaintiff, insured by defendant insurer, was injured in automobile accident and incurred expenses for transportation to medical appointments necessary to treat injuries, defendant insurer is not required to cover those transportation expenses. Dowell v. Oregon Mutual Insurance Co., 268 Or App 672, 343 P3d 283 (2015), aff’d 361 Or 62, 388 P3d 1050 (2017)
Presumption that medical expenses in personal injury protection claims are “reasonable and necessary” under this section is not conclusive and may be rebutted. McBride v. State Farm Mutual Automobile Ins. Co., 282 Or App 675, 386 P3d 679 (2016), Sup Ct review denied
Where defendant insurer failed to send timely denial of personal injury protection claims as required by this section and ORS 742.528 because of insured’s repeated failure to attend required medical examination within 60-day post-claim period to determine whether medical expenses were “reasonable and necessary,” insurer had contractual right to compel medical examination and obligation to investigate insured’s personal injury protection claims, but still had obligation under this section and ORS 742.528 to issue timely denial based on information insurer had or could reasonably obtain or expenses were presumed reasonable and necessary. McBride v. State Farm Mutual Automobile Ins. Co., 282 Or App 675, 386 P3d 679 (2016), Sup Ct review denied
Fifty-two-week limit on payment of personal injury protection benefits under automobile insurance policy applies on per-policy basis, and injured passenger receiving 52 weeks of benefits under vehicle owner’s policy may receive up to 52 weeks of additional coverage under passenger’s own policy. Padilla v. State Farm Mutual Automobile Ins. Co., 314 Or App 300, 499 P3d 100 (2021), Sup Ct review denied
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