Dowell v. Oregon Mutual Insurance Co.

388 P.3d 1050, 361 Or. 62, 2017 Ore. LEXIS 104
CourtOregon Supreme Court
DecidedFebruary 16, 2017
DocketCC 1205-06486; CA A153170; SC S063079
StatusPublished
Cited by17 cases

This text of 388 P.3d 1050 (Dowell v. Oregon Mutual Insurance Co.) is published on Counsel Stack Legal Research, covering Oregon Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dowell v. Oregon Mutual Insurance Co., 388 P.3d 1050, 361 Or. 62, 2017 Ore. LEXIS 104 (Or. 2017).

Opinions

[64]*64NAKAMOTO, J.

Auto insurers in Oregon must provide personal injury protection (PIP) benefits to their insureds for certain automotive injury-related expenses, regardless of who is at fault in an accident. ORS 742.520(1). The PIP medical benefits at issue in this case “consist of the following payments for the injury or death of each person” covered: “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.” ORS 742.524(1)(a) (2007).1 On behalf of herself and others similarly situated, plaintiff contended in her action against defendant Oregon Mutual Insurance Company that insurers must pay transportation costs incurred to obtain medical care as part of PIP medical benefits. The trial court concluded that the PIP statutes, ORS 742.518 to 742.542, do not require insurers to pay for transportation costs and granted summary judgment for defendant. Plaintiff appealed, and the Court of Appeals affirmed. Dowell v. Oregon Mutual Ins. Co., 268 Or App 672, 343 P3d 283 (2015).

The question on review is whether the PIP medical benefit in ORS 742.524(l)(a) includes the insured plaintiffs transportation costs to receive medical care. We hold that PIP benefits for the “expenses of medical * * * services” do not include an insured’s transportation costs for traveling to receive medical care. Therefore, we affirm the decision of the Court of Appeals and the judgment of the trial court.

I. BACKGROUND

The relevant facts are not in dispute. Plaintiff had an Oregon auto insurance policy issued by defendant. In 2008, plaintiff was injured in a motor vehicle accident. [65]*65Among other expenses, plaintiff incurred $430.67 in transportation costs to attend medical appointments and to obtain medication. She then applied for PIP medical benefits under her insurance policy. Defendant paid for plaintiffs medical care, but it declined to pay for her transportation expenses to obtain her medical care.

Plaintiff then filed a complaint for breach of contract, both for herself and on behalf of others similarly situated. She alleged that her claim for medical expenses under ORS 742.524(l)(a) included her transportation costs and that defendant had breached its contract by failing to reimburse her for those expenses. Defendant responded by moving for summary judgment, arguing that ORS 742.524(l)(a) did not require it to pay for transportation costs. After a hearing, the trial court granted defendant’s motion and entered a judgment in defendant’s favor.

On appeal, the Court of Appeals narrowed the case to a single question: Does the phrase “expenses of medical * * * services” in ORS 742.524(l)(a) require an insurer to pay an insured’s expenses for transportation to attend medical appointments and to obtain medication? Dowell, 268 Or App at 675.2 The Court of Appeals answered that question by considering the statute’s text and context.3 After examining dictionary definitions of the four words in the phrase “expenses of medical *** services,” the Court of Appeals concluded that, considered as a whole, the phrase meant “something that is expended to secure a benefit relating to work that is performed by another, when that work involves the practice of medicine (the maintenance of health, and the prevention, alleviation, or cure of disease).” Id. at 677. After considering the phrase’s context, particularly the remaining text of the statute and other PIP provisions pertaining to payments to “providers” of medical services, the Court of [66]*66Appeals concluded that the legislature had not intended the statute to include expenses of transportation to obtain medical services. 268 Or App at 677-78.

We allowed plaintiffs petition for review to address the interpretation of ORS 742.524(l)(a). On review, plaintiff contends that two statutes, ORS 731.008 and ORS 731.016, serve as the starting point for construing the phrase “expenses of medical * * * services.” According to plaintiff, the legislature’s declarations in those two statutes require us to liberally construe ORS 742.524(l)(a), and, read in that light, the phrase at issue should be understood as a reference to “the costs to obtain medical services,” including the costs for transportation to a doctor’s office or hospital to obtain medical advice and treatment. Consequently, plaintiff asserts that transportation costs to obtain medical services qualify as PIP benefits.

Second, plaintiff argues that the Court of Appeals decision conflicts with the purpose and policy of the PIP statutes, which is to reduce litigation and to ensure prompt payment of claims. Because health care is not available without traveling to a doctor or hospital, plaintiff argues, those travel costs are especially burdensome to rural residents who may have to travel a significant distance. Plaintiff also asserts that the reasoning of the Court of Appeals will encourage insurance companies to deny injured persons payment for medication, medical supplies, and medical equipment.

Finally, plaintiff contends that sources of law outside the PIP statutes are persuasive authority in favor of her interpretation of the statute. She relies on decisions from courts in other jurisdictions that have held that the PIP benefits in those jurisdictions include the reasonable cost of travel to a health care provider.

Defendant responds that the text and context of the statute limit payment to the cost of services expressly listed in ORS 742.524(l)(a) that are performed by a “provider,” that is, a licensed healthcare provider. Noting that the statute refers only to ambulance services and not to other transportation, and that it contains a presumption concerning payments for healthcare providers, defendant argues that PIP benefits are not meant to cover “providers of non-health [67]*67care services,” such as a taxicab or bus service, or services that insureds perform for themselves, such as driving to the doctor’s office.

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Cite This Page — Counsel Stack

Bluebook (online)
388 P.3d 1050, 361 Or. 62, 2017 Ore. LEXIS 104, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dowell-v-oregon-mutual-insurance-co-or-2017.