Oregon Statutes 87.570 – Form of notice
The form of the notice required by ORS § 87.565 shall be substantially as follows:
Terms Used In Oregon Statutes 87.570
- City: includes any incorporated village or town. See Oregon Statutes 174.100
- Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
- Lien: A claim against real or personal property in satisfaction of a debt.
- Oath: A promise to tell the truth.
- Person: includes individuals, corporations, associations, firms, partnerships, limited liability companies and joint stock companies. See Oregon Statutes 174.100
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
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Notice is hereby given that ______ has rendered hospitalization services or medical treatment for ______, a person who was injured on the ___ day of ______ in the city of ______, county of ______, State of ______, on or about the ___ day of ______, and the ______ (name of claimant) hereby claims a lien upon any money due or owing or any claim for compensation, damages, contribution, settlement, award or judgment from any person alleged to have caused the injuries and any other person liable for the injury or obligated to compensate the injured person on account of the injuries. The lien applies to any person or insurer that provides for payment for hospitalization services or medical treatment rendered to the injured person, including an insurer that provides personal injury protection coverage or similar no-fault medical insurance. The hospitalization services or medical treatment was rendered to the injured person between the ______ day of ______ and the ___ day of ______.
STATEMENT OF AMOUNT DUE
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Thirty days have not elapsed since that time. The claimant’s demand for hospitalization services or medical treatment is in the sum of $_____ and no part thereof has been paid, except $_____, and there is now due and owing and remaining unpaid thereof, after deducting all credits and offsets the sum of $_____, in which amount lien is hereby claimed.
____________, Claimant.
I, ______, being first duly sworn on oath say: That I am ______ named in the foregoing claim of lien; that I have read the same and know the contents thereof and believe the same to be true.
_______________
Subscribed and sworn to before me this ___ day of ______, 2___.
_______________, Notary Public.
______________________________________________________________________________ [Amended by 1989 c.727 § 4; 1995 c.100 § 2; 1999 c.146 § 4; 2001 c.104 § 27; 2007 c.71 § 20]