ORS 742.524
Contents of personal injury protection benefits

  • deductibles

(1)

Personal injury protection benefits required by ORS 742.520 (Personal injury protection benefits for motor vehicle liability policies) consist of the following payments for the injury or death of each person:

(a)

All reasonable and necessary expenses of medical, hospital, dental, surgical, ambulance and prosthetic services incurred within two years after the date of the person’s injury, but not more than $15,000 in the aggregate for all such expenses of the person. Expenses of medical, hospital, dental, surgical, ambulance and prosthetic services are presumed to be reasonable and necessary unless the provider receives notice of denial of the charges not more than 60 calendar days after the insurer receives from the provider notice of the claim for the services. At any time during the first 50 calendar days after the insurer receives notice of claim, the provider shall, within 10 business days, answer in writing questions from the insurer regarding the claim. For purposes of determining when the 60-day period provided by this paragraph has elapsed, counting of days shall be suspended if the provider does not supply written answers to the insurer within 10 days and may not resume until the answers are supplied.

(b)

If the injured person is usually engaged in a remunerative occupation and if disability continues for at least 14 days, 70 percent of the loss of income from work during the period of the injured person’s disability until the date the person is able to return to the person’s usual occupation. This benefit is subject to a maximum payment of $3,000 per month and a maximum payment period in the aggregate of 52 weeks. As used in this paragraph, “income” includes but is not limited to salary, wages, tips, commissions, professional fees and profits from an individually owned business or farm.

(c)

If the injured person is not usually engaged in a remunerative occupation and if disability continues for at least 14 days, the expenses reasonably incurred by the injured person for essential services that were performed by a person who is not related to the injured person or residing in the injured person’s household in lieu of the services the injured person would have performed without income during the period of the person’s disability until the date the person is reasonably able to perform such essential services. This benefit is subject to a maximum payment of $30 per day and a maximum payment period in the aggregate of 52 weeks.

(d)

All reasonable and necessary funeral expenses incurred within one year after the date of the person’s injury, but not more than $5,000.

(e)

If the injured person is a parent of a minor child and is required to be hospitalized for a minimum of 24 hours, $25 per day for child care, with payments to begin after the initial 24 hours of hospitalization and to be made for as long as the person is unable to return to work if the person is engaged in a remunerative occupation or for as long as the person is unable to perform essential services that the person would have performed without income if the person is not usually engaged in a remunerative occupation, but not to exceed $750.

(2)

With respect to the insured person and members of that person’s family residing in the same household, an insurer may offer forms of coverage for the benefits required by subsection (1)(a), (b) and (c) of this section with deductibles of up to $250. [Formerly 743.805; 1991 c.768 §7; 2003 c.813 §2; 2005 c.341 §1; 2009 c.66 §1; 2015 c.5 §4]

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

742.001
Scope of ORS chapters 742, 743, 743A and 743B
742.003
Filing and approval of policy forms
742.004
Exemptions from requirement to file rates and policy forms
742.005
Grounds for disapproval of policy forms
742.007
Director’s withdrawal of approval
742.008
Health savings account exemption from prohibition on deductible
742.009
Regulation of sales material
742.011
Insurable interest in property
742.013
Representations in applications
742.016
Policy constitutes entire contract
742.018
Provision for construction according to foreign law prohibited
742.021
Standard provisions in general
742.023
Contents of policies in general
742.026
Underwriters’ and combination policies
742.028
Additional policy contents
742.031
Bankruptcy clause required in certain liability policies
742.033
Charter and bylaw provisions
742.036
Assessment policies, special contents
742.038
Validity and construction of noncomplying forms
742.041
Permissible classes of insurance in one policy
742.043
Binders
742.046
Delivery of policy
742.048
Effective date and time of coverage
742.051
Renewal by certificate
742.053
Forms for proof of loss
742.056
Certain conduct not deemed waiver
742.058
Return of premium on destruction of property
742.061
Recovery of attorney fees in action on policy or contractor’s bond
742.063
Filing and approval of liability form that includes cost of defense within limits of liability
742.065
Insurance against risk of loss assumed under less than fully insured employee health benefit plan
742.150
Approval by director
742.152
Limitations on applicability of ORS 742.150
742.154
Factors to be considered by director in determining whether to approve assumption reinsurance agreement
742.156
Notice of transfer under assumption reinsurance agreement
742.158
Rejection of transfer by policyholder
742.160
Effect of novation of policy under assumption reinsurance agreement
742.162
Transfer and novation of policy effected by director
742.200
Fire insurance not to exceed value of property insured
742.202
Standard fire insurance policy
742.204
Exceptions to standard fire insurance policy requirements
742.206
Insuring agreement
742.208
Concealment
742.210
Uninsurable and excepted property
742.212
Perils not included
742.214
Other insurance
742.216
Conditions suspending insurance
742.218
Additional perils insured
742.220
Added provisions
742.222
Waiver provisions
742.224
Cancellation
742.226
Mortgagee interest and obligation of mortgagee
742.228
Pro rata liability of insurer
742.230
Requirements in case loss occurs
742.232
Appraisal
742.234
Insurer’s options
742.236
Abandonment
742.238
When loss payable
742.240
Suit on policy
742.242
Subrogation
742.244
Coverage for loss from nuclear reaction or radiation
742.246
Other fire insurance policy provisions permitted
742.248
Mutual fire insurers policyholders’ liability
742.250
Mutual fire insurer’s action to recover assessment
742.252
Mutual fire insurers
742.254
Mutual fire insurance policy cancellation
742.260
Cancellation of homeowner or fire policy
742.270
Repair, rebuilding or replacement of property under homeowner insurance policy
742.273
Property losses in locations subject to declarations of emergency
742.276
Estimates of cost to rebuild or replace covered property
742.280
Home protection insurance
742.282
Limitations on issuance of mortgage insurance
742.284
Insured obligations as legal investments and securities for deposit
742.286
Mortgage insurance
742.350
Bonds, undertakings and other obligations required by law may be executed by surety insurers
742.352
Reimbursement of private persons required to give bond, letter of credit or other obligation
742.354
Reimbursement of public officials required to give bond or letter of credit
742.356
Surety insurer may take measures to reduce risk of loss
742.358
Release of surety on official bonds by action of obligee
742.360
Release of surety on bond of public official by action of surety
742.362
Release of surety on depository bond
742.364
Fixing amount of new bond after release from original
742.366
Cancellation of bond by surety
742.368
Surety insurer may not deny power to execute bond
742.370
Bond construed as including omitted statutory provisions
742.372
Guaranteed arrest bond certificate
742.374
Surety may issue guaranteed arrest bond certificate not to exceed $1,000
742.376
Requirements to issue guaranteed arrest bond certificate
742.390
Reimbursement insurance policy
742.392
Termination of reimbursement insurance policy
742.400
Duty to report claim of professional negligence to licensing board
742.405
Conditions for issuance of medical malpractice insurance
742.407
Prohibition against refusing defense or indemnification of health practitioner or health care facility based on disclosure of adverse event or participation in discussion or mediation
742.420
Definitions for ORS 742.420 to 742.440
742.422
License requirement for conducting business as discount medical plan organization
742.424
Requirement for contract with provider
742.426
License application
742.428
Duties of licensee
742.430
License term
742.432
Duties of discount medical plan organization
742.434
Prohibited activities
742.436
Investigative powers of director
742.438
License suspension, revocation or failure to renew
742.440
Injunction
742.447
Proof of insurance
742.449
Prohibition on assignment to high risk category on certain grounds
742.450
Contents of motor vehicle liability policy
742.454
Liabilities that need not be covered
742.456
When insurer’s liability accrues
742.458
General provisions governing liability policies
742.460
Insurer’s right to provide for reimbursement and proration
742.462
Insurer’s right to settle claims
742.464
Excess coverage permitted
742.466
Disputes over coverage for physical damage
742.468
Certain policies not considered motor vehicle liability policies
742.480
Appropriate premium charge reduction for certain motorcycle insurance policies
742.483
Effective period for premium reduction
742.486
Issuance and presentation of certificates for motorcycle rider education course
742.490
Premium reduction
742.492
Duration of reduction
742.494
Certification of completion of course
742.496
Limitation on qualification for discount
742.500
Definitions for ORS 742.500 to 742.506
742.502
Uninsured motorist coverage
742.504
Required provisions of uninsured motorist coverage
742.505
Arbitration procedures under ORS 742.504
742.506
Allocation of responsibility among insurers
742.508
Definitions for ORS 742.508 and 742.510
742.510
Property damage coverage for damage to vehicle caused by uninsured vehicle
742.518
Definitions for ORS 742.518 to 742.542
742.520
Personal injury protection benefits for motor vehicle liability policies
742.521
Conditions applicable to arbitration proceedings
742.522
Binding arbitration under ORS 742.520
742.524
Contents of personal injury protection benefits
742.525
Provider charges
742.526
Primary nature of benefits
742.528
Notice of denial of payment of benefits
742.529
Payment based on incorrect determination of responsibility
742.530
Exclusions from coverage
742.532
Benefits may be more favorable than those required by ORS 742.520, 742.524 and 742.530
742.534
Reimbursement of other insurers paying benefits
742.536
Notice of claim or legal action to insurer
742.538
Subrogation rights of insurers to certain amounts received by injured person
742.540
Rules
742.542
Effect of personal injury protection benefits paid
742.544
Reimbursement for benefits paid
742.546
Required disclosure in release for bodily injuries related to personal injury protection benefits
742.548
Required language in disclosure
742.554
Disclosures required by insurer to motor vehicle owner when insurer declares vehicle total loss
742.558
Dispute resolution process for total loss vehicles
742.560
Definitions for ORS 742.560 to 742.572
742.562
Grounds for cancellation of policies
742.564
Manner of giving cancellation notice
742.566
Renewal of policies
742.568
Proof of cancellation, replacement or nonrenewal notice
742.570
Notifying insured under canceled or unrenewed policy of eligibility for participation in insurance pool
742.572
Immunity from liability of persons furnishing information regarding cancellation or nonrenewal of policies
742.580
Report of cancellation, nonrenewal or issuance of motor vehicle liability policy
742.585
Definitions for ORS 742.585 to 742.600
742.590
Personal vehicle sharing program requirements
742.595
Assumption of liability
742.600
Limitation on insurance policy reclassification for personal vehicle sharing program vehicle
742.690
Limitations on cancellation
742.700
Definitions for ORS 742.700 to 742.710
742.702
Grounds for cancellation
742.704
Hearing
742.706
Renewal
742.708
Proof of receipt of notice
742.710
Exemptions from provisions of ORS 742.700 to 742.708
Green check means up to date. Up to date