72nd OREGON LEGISLATIVE ASSEMBLY--2003 Regular Session
 
NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .
 
LC 393
 
                         Senate Bill 55
 
Printed pursuant to Senate Interim Rule 213.28 by order of the
  President of the Senate in conformance with presession filing
  rules, indicating neither advocacy nor opposition on the part
  of the President (at the request of Joint Interim Committee on
  Health and Human Resources for Chiropractic Association of
  Oregon)
 
 
                             SUMMARY
 
The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.
 
  Allows insurer or beneficiary to request independent medical
examination when personal injury protection benefits claim is
disputed. Creates Personal Injury Protection Independent Medical
Examination Program in Department of Consumer and Business
Services.
 
                        A BILL FOR AN ACT
Relating to personal injury protection benefits.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + Sections 2 to 5 of this 2003 Act are added to
and made a part of ORS 742.520 to 742.542. + }
  SECTION 2.  { + (1) An insurer issuing motor vehicle liability
insurance policies in this state must have an independent medical
examination program that meets the requirements of this section
and section 3 of this 2003 Act. Each insurer must allow a
beneficiary, by applying to the insurer, to obtain an independent
medical examination through the Personal Injury Protection
Independent Medical Examination Program created under section 4
of this 2003 Act when a claim for personal injury protection
benefits relating to health care services is disputed. Each
insurer shall provide the independent medical examination through
the Personal Injury Protection Independent Medical Examination
Program.
  (2) If an insurer requests an independent medical examination
when a claim for personal injury protection benefits relating to
health care services is disputed, the insurer shall obtain the
independent medical examination through the Personal Injury
Protection Independent Medical Examination Program. A beneficiary
must cooperate with a request by an insurer for an independent
medical examination. + }
  SECTION 3.  { + (1) An insurer issuing motor vehicle liability
insurance policies in this state shall provide information
regarding the Personal Injury Protection Independent Medical
Examination Program created under section 4 of this 2003 Act to
an insured:
  (a) At the time of application for a policy;
  (b) At the time of renewal of a policy; and
  (c) When a dispute arises between an insurer and a beneficiary
about the amount of personal injury protection benefits or about
the denial of personal injury protection benefits relating to
health care services.
  (2) The information provided under subsection (1) of this
section shall include:
  (a) A statement of the right of a beneficiary to apply for an
independent medical examination by a health care provider on the
list maintained by the Department of Consumer and Business
Services under section 4 of this 2003 Act;
  (b) A description of the procedures for requesting an
independent medical examination;
  (c) A description of the procedures for responding to a request
by an insurer for an independent medical examination;
  (d) A description of the duties of a health care provider who
conducts an independent medical examination; and
  (e) A description of the options available to the beneficiary
after the independent medical examination is conducted. + }
  SECTION 4.  { + (1) The Personal Injury Protection Independent
Medical Examination Program is created in the Department of
Consumer and Business Services. The purpose of the program is to
develop and maintain a list of health care providers who are
qualified to conduct independent medical examinations under
section 2 of this 2003 Act.
  (2) A health care provider who conducts an independent medical
examination under section 2 of this 2003 Act shall determine:
  (a) Whether the treatment provided to the beneficiary was
reasonable and necessary; and
  (b) Whether the injury or condition arose out of the use of a
motor vehicle.
  (3) An independent medical examination must be conducted by a
health care provider whose professional specialty is the same as
or comparable to the health care provider whose claim is
disputed.
  (4) The insurer shall pay a health care provider for the cost
of an independent medical examination.
  (5) The Director of the Department of Consumer and Business
Services shall collect a fee as described in ORS 731.804 for the
Personal Injury Protection Independent Medical Examination
Program. + }
  SECTION 5.  { + (1) The Director of the Department of Consumer
and Business Services shall adopt rules governing independent
medical examinations conducted under section 2 of this 2003 Act.
The rules shall include but not be limited to:
  (a) Professional qualifications of health care providers
conducting independent medical examinations;
  (b) Criteria requiring health care providers to demonstrate
protections against bias and conflicts of interest;
  (c) Procedures for conducting independent medical examinations;
  (d) Procedures for complaint investigations;
  (e) Procedures for ensuring the confidentiality of medical
records transmitted to a health care provider conducting an
independent medical examination;
  (f) Fairness of procedures used by health care providers;
  (g) Fees for independent medical examinations;
  (h) Timelines for decision making and notice to the parties;
and
  (i) Quality assurance mechanisms to ensure timeliness and
quality of independent medical examinations.
  (2) The director shall develop procedures for assigning
requests to health care providers to conduct independent medical
examinations. The examinations shall be assigned on a random
basis. The procedures shall allow a beneficiary or insurer one
opportunity to reject the assignment of a health care provider to
a particular independent medical examination. + }
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