PIP claimants often include miscellaneous expenses that they believe are related to medical care. In this case, the insured claimed expenses for travel to and from doctor visits and the insurer refused to pay. Find out how the Court of Appeals decided this issue below.
Claims Pointer: For the first time, the Court of Appeals held that travel expenses related to medical appointments and treatments do not fall under the definition of medical expenses. The court made its decision by stating that travel expenses are not administered through a “provider,” as used in the statute. The court specifically refused to address whether other expenses related to medical care such as crutches, wheelchairs, walkers, bandages, acupuncture, and chiropractic work are covered under ORS 742.524(1)(a).
Dowell v. Oregon Mutual Ins. Co., 268 Or App 672 (2015).
In 2008, Stephanie M. Dowell was involved in a motor vehicle accident in which she was injured. At the time, Dowell was insured by Oregon Mutual Insurance Company, which provided PIP coverage as required by Oregon law. When Dowell applied for PIP benefits for medical expense, Oregon Mutual paid out the claim. In addition to medical expenses, Dowell submitted a claim for $430.67 for travel expenses related to her medical treatment. Oregon Mutual denied the claim for travel expenses. Dowell filed suit for breach of contract, alleging that the expense of transportation was necessary to her medical treatment because she needed to be able to receive treatment and obtain medication.
Oregon Mutual filed a motion for summary judgment for failure to state a claim. The trial court granted summary judgment and issued a judgment in Oregon Mutual’s favor. Dowell appealed. On appeal, the only dispute was that ORS 742.524(1)(a) (relating to PIP coverage for medical expenses) requires an insurer to pay for travel expenses that are necessary for medical treatment.
Dowell argued that the legislature could not have intended to limit medical expenses under ORS 742.524 to “the narrow list of medical, hospital, dental, surgical, ambulance and prosthetic services,” because the purpose of mandatory PIP coverage was to benefit the public. Furthermore, she argued that the statute should be interpreted broadly to include expenses directly related to medical treatment such as travel costs.
Oregon Mutual, on the other hand, focused its argument on the phrase “expenses of medical … services” – arguing that ORS 742.524(1)(a) only extends to services provided, not medically related expenses such as travel. Oregon Mutual also argued that “expenses of medical … services” must be provided by a licensed health care professional to be payable as a PIP benefit.
In order to reach a conclusion, the Court of Appeals of Oregon examined the legislative intent behind ORS 742.524(1)(a). The court observed that a plain reading of the statute made clear that “expenses of medical … services” are expenditures to secure work that involves the practice of medicine. Moreover, the court’s reading of the statute was supported by context because a PIP claim is not payable unless the insurer receives a notice of claim from a “provider.” The court held that expenses related to travel to medical appointments and to obtain medication are not “expenses of medical … services” under the statute. In light of its holding, the court concluded that Oregon Mutual was not required to pay Dowell for travel expenses incurred to receive medical treatment and affirmed the trial court’s ruling in favor of Oregon Mutual.
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