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Dowell v. Or. Mut. Ins. Co.

Court of Appeals of Oregon

January 28, 2015

Stephanie M. DOWELL, individually and on behalf of others similarly situated, Plaintiff-Appellant,
v.
OREGON MUTUAL INSURANCE COMPANY, an Oregon corporation, Defendant-Respondent

Argued and Submitted October 7, 2014

Multnomah County Circuit Court. 120506486. Henry C. Breithaupt, Judge pro tempore.

Charles Robinowitz argued the cause for appellant. With him on the opening brief was Lee Ann Donaldson. With him on the reply brief were Lee Ann Donaldson and Law Offices of Charles Robinowitz.

Thomas M. Christ argued the cause for respondent. With him on the brief was Cosgrave Vergeer Kester LLP.

Before Sercombe, Presiding Judge, and Hadlock, Judge, and Tookey, Judge.

OPINION

Page 284

[268 Or.App. 673] TOOKEY, J.

Plaintiff, the insured, appeals a general judgment in favor of defendant, Oregon Mutual Insurance Company, after the trial court granted defendant's motion for summary judgment on plaintiff's claim for breach of contract. For the reasons that follow, we affirm.

The material facts are not in dispute. Plaintiff was insured under a motor vehicle insurance policy issued by defendant. As statutorily required, plaintiff's insurance policy included personal injury protection (PIP) coverage, which is Oregon's version of " no fault" motor vehicle insurance.[1] Under the PIP statutory scheme, when an insured is injured in a motor vehicle accident, regardless of fault, the insurer is required to pay certain expenses, as follows:

" (1) Personal injury protection benefits as required by ORS 742.520 shall 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 one year 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 shall be presumed to be reasonable and necessary unless the provider is given 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,

Page 285

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 [268 Or.App. 674] answers to the ...

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