Dowell v. Oregon Mutual Insurance

343 P.3d 283, 268 Or. App. 672, 2015 Ore. App. LEXIS 87
CourtCourt of Appeals of Oregon
DecidedJanuary 28, 2015
Docket120506486; A153170
StatusPublished
Cited by8 cases

This text of 343 P.3d 283 (Dowell v. Oregon Mutual Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon 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, 343 P.3d 283, 268 Or. App. 672, 2015 Ore. App. LEXIS 87 (Or. Ct. App. 2015).

Opinion

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 plaintiffs 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, plaintiffs 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, 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 [674]*674answers to the insurer within 10 days and may not resume until the answers are supplied.”

ORS 742.524(l)(a).2

In 2008, while insured by defendant, plaintiff was injured in a motor vehicle accident, and she applied for PIP medical benefits, which defendant paid. She also incurred $430.67 in expenses for transportation to attend medical appointments and to obtain medication, but defendant declined to pay those expenses.

Plaintiff then initiated this action by filing, individually, and on behalf of others similarly situated, a complaint for breach of contract against defendant. In her complaint, plaintiff alleged that her claim for medical expenses under ORS 742.524(l)(a) included the expense of transportation to attend medical appointments and to obtain medication, and that defendant breached its contract by failing to reimburse her for those expenses. Defendant moved for summary judgment, arguing that ORS 742.524(l)(a) did not require it to pay plaintiffs transportation expenses. After a hearing, the trial court granted defendant’s motion for summary judgment, and entered a judgment in favor of defendant.

On appeal, plaintiff contends that the trial court erred when it granted defendant’s motion for summary judgment. That ruling involves interpretation of a statute, which we review for legal error. See State v. Thompson, 328 Or 248, 256, 971 P2d 879, cert den, 527 US 1042 (1999) (“A trial court’s interpretation of a statute is reviewed for legal error.”).3

[675]*675In this case, the parties do not dispute that the medical services obtained by plaintiff were reasonable and necessary, and they do not dispute the underlying facts. Rather, the parties dispute only one issue — whether ORS 742.524(l)(a) requires defendant to pay plaintiffs expenses for transportation to attend medical appointments and to obtain medication. Accordingly, the parties focus their arguments on the meaning of the following phrase: “expenses of medical *** services.” ORS 742.524(1)(a).

Plaintiff argues that the phrase “expenses of medical * * * services” in ORS 742.524(l)(a) includes the expense of transportation to obtain those services. She first states that “the legislature did not intend to limit payment of medical expenses solely to the narrow list of medical, hospital, dental, surgical, ambulance and prosthetic services.”4 She also argues that the legislature’s description of the specific covered services in ORS 742.524(l)(a) cannot be “considered literally” because such a reading “is not logical or consistent” with the legislative purpose of protecting the insurance-buying public. See ORS 731.008 (“The Legislative Assembly declares that the Insurance Code is for the protection of the insurance-buying public.”). According to plaintiff, ORS 742.524(l)(a) should be broadly construed to mean “that an insured is entitled to expenses related to, in reference to, or about medical services!,]” including “the insured’s costs of traveling to and from the appointments.” (Internal quotation marks omitted.)

Defendant responds that the phrase “expenses of medical *** services” does not include the expense of transportation to obtain those services. Defendant argues that, under ORS 742.524(l)(a), PIP benefits are limited to payments for certain “services” — namely, “medical, hospital, dental, surgical, ambulance and prosthetic services [.]” Defendant also argues that ORS 742.524(l)(a) “contemplates [676]*676that the services for which benefits are required will be provided by a ‘provider’” — that is, “a licensed health care provider.” (Emphasis in original.) Thus, according to defendant, the context demonstrates that PIP benefits are required neither “for providers of non-health care services” — such as taxi cab service, shuttle service, or bus service — nor “for services for which there is no ‘provider’ — that is, for services the injured ‘person’ performs for himself, such [as] driving himself to the doctor’s office.” (Emphasis in original.)

When interpreting a statute, our goal is to discern legislative intent. State v. Gaines, 346 Or 160, 171, 206 P3d 1042 (2009). We consider the text and context, and, where it is helpful, legislative history. Id. at 171-73. We start with the statutory text because it is “the best evidence of the legislature’s intent.” PGE v. Bureau of Labor and Industries,

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Related

Bialostosky v. Cummings
511 P.3d 31 (Court of Appeals of Oregon, 2022)
State v. Jackson
507 P.3d 727 (Court of Appeals of Oregon, 2022)
Dowell v. Oregon Mutual Insurance Co.
388 P.3d 1050 (Oregon Supreme Court, 2017)
Dowell v. Oregon Mutual Ins. Co.
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Landis v. Liberty Northwest Insurance Corp.
383 P.3d 349 (Court of Appeals of Oregon, 2016)

Cite This Page — Counsel Stack

Bluebook (online)
343 P.3d 283, 268 Or. App. 672, 2015 Ore. App. LEXIS 87, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dowell-v-oregon-mutual-insurance-orctapp-2015.