2007 Oregon Code - Chapter 445 :: Chapter 445 - Indigent Persons Injured in Motor Vehicle Accidents
Chapter 445 —
Indigent Persons Injured in Motor Vehicle Accidents
2007 EDITION
INDIGENT PERSONS INJURED IN VEHICLE ACCIDENTS
PUBLIC HEALTH AND SAFETY
445.010Â Â Â Â Definitions
445.020Â Â Â Â Determination
of indigency
445.030Â Â Â Â Motor
Vehicle Accident Fund; source; uses
445.050Â Â Â Â Jurisdiction;
rules
445.060Â Â Â Â Limitation
on benefits for care supplied
445.070Â Â Â Â Additional
benefits permitted within limits
445.090Â Â Â Â Filing
of claims; time for filing
445.110Â Â Â Â Hospital
claims; form and contents
445.120Â Â Â Â Filing
of claims generally; combining claims
445.130Â Â Â Â Effect
of liability of third person or commencement of legal action on settlement of
claim
445.140Â Â Â Â Audit
and determination of validity of claims
445.150Â Â Â Â Order
allowing or rejecting claim; notice
445.155Â Â Â Â Judicial
review
445.180Â Â Â Â Reassignment
of rights to claimant on notice of finding person liable for care
445.185Â Â Â Â When
deduction may be made from payments on claim
445.270Â Â Â Â Limitation
on entitlement to benefits
     445.010
Definitions. As used in this
chapter, unless the context requires otherwise:
     (1) “Ambulance operator” means any person
operating an ambulance for hire.
     (2) “Care” means:
     (a) Treatment in and by a hospital.
     (b) Professional services of a doctor.
     (c) Professional services of a nurse.
     (d) Medicines, substances, articles,
appliances or physical therapy supplied on the prescription or order of the
doctor in charge of the case.
     (e) Transportation and services by an
ambulance operator.
     (f) Supplying prosthetic appliances and
services.
     (g) Any combination of any two or more of
the services listed in this subsection.
     (h) Professional services of a licensed
physical therapist.
     (3) “Claimant” means a hospital, doctor,
nurse, pharmacy, ambulance operator, supplier of prosthetic appliances and
services or licensed physical therapist, who supplies care to an indigent
patient, and who files a claim for charges therefor pursuant to this chapter.
In respect of a hospital, it includes the operator or managing officer thereof.
“Claimant” also means an indigent patient, or a personal representative of the
patient after the death of the patient, but claims allowed shall be paid
directly to those who supply care to the indigent patient; and an indigent
claimant, or personal representative of the patient, has no right of appeal
under ORS 445.160 (1969 Replacement Part).
     (4) “Department” means the Department of
Human Services.
     (5) “Doctor” means a person licensed by
the appropriate board of this state to practice one or more of the healing
arts.
     (6) “Hospital” includes nursing homes and
means any institution that has a provider agreement with the department and
which admits and cares for patients suffering from motor vehicle injuries and
applies for the benefits of this chapter in the manner provided in ORS 445.110.
     (7) “Indigent patient” means a person who
has suffered a motor vehicle injury and who is unable to pay the cost of the
care supplied on account of such injury and, except in the case of a claim
filed after a claim arising out of the same motor vehicle injury has been
allowed by the department or finally adjudged affirmatively by a court on
appeal, whose account therefor remains unpaid at the expiration of 90 days
after the termination of the care and who is not entitled to the benefits of
the WorkersÂ’ Compensation Law of this state or any other state or country on
account of such injury.
     (8) “Motor vehicle injury” means any
personal injury suffered by a human being, and accidentally caused in, by, or
as the proximate result of, the movement of a motor vehicle on a public way,
street or highway within this state, whether the injured person is the operator
of the vehicle, a passenger in the same or another vehicle, a pedestrian or
whatever the relationship of the injured person to the movement of the vehicle,
and whether or not the vehicle is under the control of a human being at the
time of the injury.
     (9) “Nurse” means a person registered or
licensed to practice nursing by the Oregon State Board of Nursing.
     (10) “Pharmacy” means a place of business
licensed by the State Board of Pharmacy, where drugs, medicines, prescriptions,
chemicals or poisons are compounded, dispensed or sold at retail.
     (11) “Supplier of prosthetic appliances
and services” means a place of business or person licensed to manufacture or
supply prosthetic appliances and services.
     (12) “Licensed physical therapist” means a
physical therapist within the State of
     445.020
Determination of indigency.
(1) A person injured by the movement of a motor vehicle is deemed unable to pay
the charges for care if it appears that, upon due and diligent search and
inquiry, the person, or any other person chargeable by law with the care or
support of the person, cannot be found for service of summons, or that, should
an action be brought and judgment secured against the person, or against any
other person chargeable by law with the care or support of the person, for the
amount of the charges, execution thereon would be unavailing.
     (2) Indigency of a patient shall be
determined as of the date on which the patient becomes unable to pay the cost
of the care.
     445.030
Motor Vehicle Accident Fund; source; uses. (1) There is created a fund to be known as the Motor Vehicle Accident
Fund, to be held and deposited by the State Treasurer in such banks as are
authorized to receive deposits of the General Fund.
     (2) All moneys received by the Department
of Human Services under this chapter shall forthwith be paid to the State
Treasurer, and shall become a part of the fund.
     (3) The following shall be paid from the
fund:
     (a) All claims and benefits allowed by the
department or finally adjudged affirmatively by a court on appeal in the
amounts allowed or adjudged and within the limitations of ORS 445.060 and
445.070.
     (b) All expenses of litigation incurred by
the department on any appeal.
     (c) All court costs and disbursements
assessed against the department.
     (d) All salaries, clerk hire, advances and
reimbursement of travel costs and expenses incurred by the department in the
administration of this chapter.
     (e) Expenses incurred by the department in
the administration of the Emergency Medical Services and Trauma Systems Program
created pursuant to ORS 431.623. The total amount of all payments from the fund
for purposes of this paragraph shall be equal to $891,450 each biennium.
     (4) Liability for payment of claims or
judgments thereon, or both, and expenses authorized by this chapter shall be
limited to the fund and all additions thereto made under this chapter. [Amended
by 1965 c.376 §2; 1983 c.338 §29; 1983 c.740 §165; 1985 c.279 §4; 1997 c.546 §1;
2001 c.668 §6]
     445.040 [Repealed by 1961 c.672 §2]
     445.050
Jurisdiction; rules. The
Department of Human Services may:
     (1) Hear and determine all questions
within its jurisdiction.
     (2) Promulgate and enforce all rules and
regulations as may be proper in the administration and enforcement of this
chapter. [Amended by 1985 c.279 §5]
     445.060
Limitation on benefits for care supplied. Except as provided in ORS 445.070, the payment of benefits authorized
by this chapter is limited to care supplied within one year from the date of
the motor vehicle injury and is further limited so that for care supplied to
any one indigent patient by reason of any one motor vehicle injury:
     (1) No hospital or hospitals shall receive
from the fund more than $6,000, in the aggregate, except that a Level I or II trauma
hospital or hospitals may receive up to $12,000, in the aggregate.
     (2) No doctor or doctors shall receive
from the fund more than $2,500, in the aggregate.
     (3) No nurse or nurses shall receive from
the fund more than $500, in the aggregate.
     (4) No pharmacy or pharmacies shall
receive from the fund more than $500, in the aggregate.
     (5) No ambulance operator or ambulance
operators shall receive from the fund more than $500, in the aggregate, except
that an air ambulance or air ambulances may receive up to $2,000, in the
aggregate.
     (6) No supplier or suppliers of prosthetic
appliances and services shall receive from the fund more than $500, in the
aggregate.
     (7) No licensed physical therapist or
licensed physical therapists shall receive from the fund more than $500, in the
aggregate. [Amended by 1953 c.399 §2; 1969 c.260 §2; 1973 c.141 §2; 1997 c.546 §2]
     445.070
Additional benefits permitted within limits. If it is made to appear to the Department of Human Services that the
limitations of ORS 445.060 are not sufficient to provide necessary and adequate
care of an indigent patient and that the condition of the indigent patient
warrants such action, the department, in its sole discretion, the exercise of
which shall be conclusive and not in any wise subject to review, may authorize
the supplying of additional care to the indigent patient of the same type as
the types of initial care authorized by this chapter and may pay for the same
from the Motor Vehicle Accident Fund. No claim for additional care shall be
enforceable under this chapter unless the department first approves and
authorizes in writing the supplying of such additional care. No single
authorization shall be for more than:
     (1) For additional care supplied by a
hospital or hospitals, $500.
     (2) For additional care supplied by a
doctor or doctors, $300.
     (3) For additional care supplied by a
nurse or nurses, $200.
     (4) For additional care supplied by a
pharmacy or pharmacies, $100.
     (5) For additional care supplied by an
ambulance operator or ambulance operators, $50.
     (6) For additional care supplied by a
supplier or suppliers of prosthetic appliances and services, $100.
     (7) For additional care supplied by a
licensed physical therapist or licensed physical therapists, $100. [Amended by
1969 c.260 §3; 1973 c.141 §3; 1985 c.279 §6]
     445.080 [Amended by 1983 c.45 §1; repealed by 1985
c.279 §14]
     445.090
Filing of claims; time for filing. (1) At the time of filing a claim under this chapter, the claimant
shall submit to the Department of Human Services such information and data as
the department may reasonably require.
     (2) A claim filed under this chapter must
be filed with the department within one year after the termination of the care
supplied by the claimant. However, in computing the time there shall not be
included that period beginning when any claim under ORS chapter 656 arising out
of the same motor vehicle accident is filed by the indigent patient with the
department, and ending when that claim has been finally decided. [Amended by 1953
c.399 §3; 1959 c.676 §1; 1965 c.376 §3; 1969 c.260 §4; 1983 c.45 §2]
     445.100 [Repealed by 1965 c.376 §6]
     445.110
Hospital claims; form and contents. Each claim shall be made in writing in the form prescribed by the
Department of Human Services, and shall show, and be accompanied by, the
following matters and things:
     (1) The name and last-known post-office
address of the person to whom care has been given.
     (2) The number of days’ care, with the
dates of admission to the hospital and of discharge therefrom or other
termination of care.
     (3) The amount of the claim.
     (4) A statement in writing showing the
effort made by the hospital to collect the amount of the claim, the facts
indicating the indigency of the patient, and the amount, if any, of money received
from the patient or others in payment of the account of the patient.
     (5) If reasonably obtainable, the
affidavit of the indigent patient or of the person or agency, if any,
responsible for the patient, and, if reasonably obtainable, the statement in
writing of a public or private agency engaged in the relief of the poor,
verifying the indigency of the patient. If the affidavit or statement does not
accompany the claim, and it is alleged in the claim that such absence is owing
to the fact that the affidavit or statement is not reasonably obtainable, the
claim shall set forth the facts upon which such assertion is based.
     (6) Any other information and data the
department may reasonably require. [Amended by 1965 c.376 §4; 1983 c.45 §3;
1985 c.279 §7]
     445.120
Filing of claims generally; combining claims. (1) The claim of a claimant other than a hospital shall be in form and
substance like that provided in ORS 445.110 in so far as applicable and be
accompanied by the same supporting documents. However, only one set of
supporting documents need be filed in respect of any one indigent patient in
regard to any one motor vehicle injury.
     (2) An account for the services of an
orthodontist for orthodontia performed by the orthodontist on the order of the
doctor in charge of the case or an account for care supplied by a nurse,
pharmacy, ambulance operator, supplier of prosthetic appliances and services or
services of a licensed physical therapist may be, with the consent of the
doctor, assigned to, and included as a part in and of the claim of, a hospital
or doctor. [Amended by 1969 c.260 §5; 1973 c.141 §4]
     445.130
Effect of liability of third person or commencement of legal action on
settlement of claim. For the
purposes of claims under ORS 445.110 and 445.120, an indigent patient who is
not otherwise able to pay the charges for care supplied shall not be deemed to
be able to pay them because a third person might be held liable in an action to
recover damages on account of the motor vehicle injury, if an action has not
been commenced. If an action has been commenced, the claim shall show that
fact. In that event the Department of Human Services may suspend the
determination of the claim until the action has been terminated and from time
to time require the claimant to supply such further information and data in
respect of the action as the department may deem necessary in order to
determine the ultimate ability of the patient to pay the charges for which the
claim is filed. [Amended by 1985 c.279 §8]
     445.140
Audit and determination of validity of claims. The Department of Human Services shall
examine and audit each claim filed with it under this chapter. From the
information and data contained in the claim, the reports of the claimant, the
documents so accompanying and supporting the claim and such other evidence as
it may reasonably require or itself adduce, the department shall find and
determine:
     (1) Whether or not the claim has been
filed within the time limited in ORS 445.090.
     (2) Whether or not the claim is predicated
upon care supplied to a person suffering from a motor vehicle injury.
     (3) Whether or not the injured person is
unable to pay the charges for which the claim is filed, within the meaning of
ORS 445.020.
     (4) Whether or not the claimant has made
reasonable and timely effort to effect collection of its claim. [Amended by
1969 c.260 §6; 1985 c.279 §9]
     445.150
Order allowing or rejecting claim; notice. (1) If, in the matter of the claim, the Department of Human Services
finds and determines in the affirmative in respect of items listed in ORS
445.140, it shall, by its order made and filed in the matter, allow the claim
in such amount, not exceeding the limitations in ORS 445.060 and 445.070, less
such amount as has been paid on the account.
     (2) If in its judgment the maintenance of
the solvency of the Motor Vehicle Accident Fund so requires, the department may
make payment in monthly installments of any claim which has been allowed by it,
or finally adjudged affirmatively by a court on appeal.
     (3) If the department finds and determines
in the negative in respect of any item listed in ORS 445.140, it shall, by its
order made and filed therein, reject the claim.
     (4) The department promptly shall serve
the claimant with a copy of its order, addressed to the claimant at the
claimantÂ’s last-known post-office address as shown by the records and files of
the department. [Amended by 1983 c.45 §5; 1983 c.740 §116; 1985 c.279 §10]
     445.155
Judicial review. Judicial
review of regulations under ORS 445.050 and orders under ORS 445.150 shall be
in accordance with ORS chapter 183, provided that the amount involved in the
appeal from the order exceeds $100, and provided further that the amount
involved in the appeal from the decision of the court exceeds $500. [1971 c.734
§62]
     445.160 [Repealed by 1971 c.734 §21]
     445.170 [Repealed by 1985 c.279 §14]
     445.180
Reassignment of rights to claimant on notice of finding person liable for care. (1) If it comes to the knowledge of a
claimant who has received payment of a claim under this chapter that the
patient in respect of whom the claim has been paid, or any other person
chargeable by law with the care or support of the patient, has been paid, or is
able to pay, the amount of the claim, the claimant shall diligently pursue such
payment.
     (2) A claimant who has received payment of
a claim from the Department of Human Services under this chapter shall inform
the department promptly and in writing if:
     (a) The claimant receives any payment from
or on behalf of the patient in respect of whom the claim has been paid or from
any person chargeable by law with the care or support of the patient;
     (b) The claimant knows or has reason to
believe that the patient or any person chargeable by law with the care or
support of the patient is able to pay the amount of the claim or any part
thereof; or
     (c) The claimant or any person on behalf
of the claimant institutes an action against the patient or any person
chargeable by law with the care or support of the patient to recover all or
part of the amount of the claim.
     (3) All moneys paid to or for the use or
benefit of the claimant by or on behalf of the patient shall, after deduction
of the reasonable cost of recovering them, be paid to the department for
deposit in the Motor Vehicle Accident Fund. [Amended by 1985 c.279 §11]
     445.185
When deduction may be made from payments on claim. When a claimant fails to pursue payment as
required by ORS 445.180 or to pay to the Department of Human Services the
amount required by ORS 445.180 to be paid, the department shall, after 60 days,
deduct the amount paid by it on the claim from any subsequent payment made to
the claimant unless it is made to appear to the satisfaction of the department
that:
     (1) Upon due and diligent search and
inquiry neither the patient nor any person chargeable by law with the care or
support of the patient can be found;
     (2) An action against the patient or a
person chargeable by law with the care or support of the patient has been
instituted and is pending; or
     (3) An action has been prosecuted to final
judgment, all legal remedies for satisfaction of the judgment have been
exhausted and the judgment has not been collected. [1985 c.279 §13]
     445.190 [Repealed by 1985 c.279 §14]
     445.200 [Repealed by 1985 c.279 §14]
     445.210 [Repealed by 1985 c.279 §14]
     445.220 [Repealed by 1985 c.279 §14]
     445.230 [1961 c.470 §2; repealed by 1985 c.279 §14]
     445.240 [1961 c.470 §3; 1983 c.45 §4; repealed by
1985 c.279 §14]
     445.250 [1961 c.470 §4; repealed by 1985 c.279 §14]
     445.260 [1961 c.470 §5; repealed by 1985 c.279 §14]
     445.270
Limitation on entitlement to benefits. (1) Notwithstanding any other provision of this chapter, benefits are
not available under this chapter for any person who is entitled to benefits
under ORS 414.032.
     (2) Nothing in this section limits any
payment specifically provided by law to the Department of Human Services from
the Motor Vehicle Accident Fund for the purpose of reimbursing the department
for the costs of care provided to indigent patients under ORS 414.032. [1983
c.126 §3]
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