Chapter 692 Oregon Laws 2007

AN ACT

HB 3490

Relating to proof of loss; creating new provisions; and amending ORS 742.518.

Be It Enacted by the People of the State of Oregon:

SECTION 1. ORS 742.518 is amended to read:

742.518. As used in ORS 742.518 to 742.542:

(1) “Evaluation services” means physical examinations or reviews of medical records of beneficiaries conducted at the request of an insurer by either an employee of the insurer or a third-party medical record or bill review service to determine whether the provision or continuation of medical services is necessary or reasonable.

(2) “Managed care services” means any system of health care delivery that attempts to control or coordinate use of health care services in order to contain health care expenditures or improve quality of health care services.

(3) “Motor vehicle” means a self-propelled land motor vehicle or trailer, other than:

(a) A farm-type tractor or other self-propelled equipment designed for use principally off public roads, while not upon public roads;

(b) A vehicle operated on rails or crawler-treads; or

(c) A vehicle located for use as a residence or premises.

(4) “Motorcycle” and “moped” have the meanings given those terms in ORS 801.345 and 801.365.

(5) “Occupying” means in, or upon, or entering into or alighting from.

(6) “Pedestrian” means a person while not occupying a self-propelled vehicle other than a wheelchair or a similar low-powered motorized or mechanically propelled vehicle that is designed specifically for use by a physically disabled person and that is determined to be medically necessary for the occupant of the wheelchair or other low-powered vehicle.

(7) “Personal injury protection benefits” means the benefits described in ORS 742.518 to 742.542.

(8) “Private passenger motor vehicle” means a four-wheel passenger or station wagon type motor vehicle not used as a public or livery conveyance, and includes any other four-wheel motor vehicle of the utility, pickup body, sedan delivery or panel truck type not used for wholesale or retail delivery other than farming, a self-propelled mobile home and a farm truck.

(9) “Proof of loss” means documentation that allows an insurer to determine whether a person is entitled to personal injury protection benefits and the amount of any benefit that is due.

[(9)] (10) “Provider” has the meaning given that term in ORS 743.801.

SECTION 2. Section 3 of this 2007 Act is added to and made a part of ORS 742.518 to 742.542.

SECTION 3. If personal injury protection benefits are paid based on information that appeared to establish proof of loss and the insurer paying the benefits later determines the insurer was not responsible for the payment, the insurer shall give notice and explanation to the provider that the payment was incorrectly issued. Immediately after receiving the notice and explanation the provider shall promptly repay the insurer.

Approved by the Governor June 27, 2007

Filed in the office of Secretary of State June 27, 2007

Effective date January 1, 2008

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