The Oregon Supreme Court, over a vigorous dissent, has ruled that personal injury protection (“PIP”) benefits owed by an insurer to an insured did not include the insured's transportation costs to receive medical care.
The Case
Stephanie M. Dowell was injured in a motor vehicle accident. Among other expenses, she 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. Her insurer, Oregon Mutual Insurance Company, paid for her medical care, but it declined to pay for her transportation expenses to obtain her medical care.
Ms. Dowell sued, alleging that her claim for medical expenses under ORS 742.524(1)(a) included her transportation costs and that Oregon Mutual had breached its contract by failing to reimburse her for those expenses.
The trial court granted summary judgment in favor of the insurer, and the appellate court affirmed.
The dispute reached the Oregon Supreme Court.
Oregon Law
Oregon law provides that personal injury protection benefits:
consist of the following payments for the injury or death of each [covered] person[:]
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).
The law also provides:
Expenses of medical . . . 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.
It defines:
provider
as:
a person licensed, certified or otherwise authorized or permitted by laws of this state to administer medical or mental health services in the ordinary course of business or practice of a profession.
ORS 743.801(13).
The Oregon Supreme Court's Decision
The court affirmed.
After reviewing the text and the legislative history, the court ruled that the phrase “expenses of medical . . . services” in ORS 742.524(1)(a) included (1) the cost of professional services provided by licensed or certified healthcare providers and (2) medications and medical supplies and equipment that they have prescribed for the injured motorists that they treat.
Accordingly, it agreed with the trial and appellate courts that the legislature did not intend transportation costs for medical care to be a PIP benefit.
The dissent said:
Had the majority given effect to the statute's text, context, and legislative history, and followed the lead of all courts that have considered the question, the majority would have interpreted ORS 742.524(1)(a) to require insurers to pay transportation costs.
The case is Dowell v. Oregon Mutual Ins. Co., No. SC S063079 (Ore. Feb. 16, 2017). Attorneys involved include: Charles Robinowitz, Law Offices of Charles Robinowitz, Portland, argued the cause and filed the briefs for petitioner on review. Also on the briefs was Genavee Stokes-Avery. Thomas M. Christ, Cosgrave Vergeer Kester LLP, Portland, argued the cause and filed the briefs for respondent on review. Hadley Van Vactor, Portland, filed the brief for amicus curiae Oregon Trial Lawyers Association.
FC&S Legal Comment
The majority approach among the states that have decided the issue is that transportation expenses to and from health care providers are reimbursable PIP expenses. See, Malu v. Security Nat'l Ins. Co., 898 So.2d 69 (Fla. 2005); Allstate Ins. Co. v. Smith, 902 P.2d 1386 (Colo. 1995); Plemmons v. New Jersey Auto. Full Ins. Underwriting Ass'n, 622 A.2d 275 (N.J. Super. Ct.App. 1993); Davis v. Citizens Ins. Co. of America, 489 N.W.2d 214 (Mich. Ct.App. 1992).
Steven A. Meyerowitz
Steven A. Meyerowitz, a Harvard Law School graduate, is the founder and president of Meyerowitz Communications Inc., a law firm marketing communications consulting company. He may be contacted at [email protected].