Dowell v. Oregon Mutual Insurance Co.
361 Or. 62
| Or. | 2017Background
- Plaintiff (insured) was injured in a 2008 auto accident and incurred $430.67 in transportation costs to attend medical appointments and obtain medication; insurer paid medical bills but refused to reimburse transportation costs.
- Plaintiff sued Oregon Mutual for breach of contract on behalf of a class, claiming ORS 742.524(1)(a)’s PIP "expenses of medical
- services" includes travel costs to obtain care.
- Trial court granted summary judgment for defendant; the Court of Appeals affirmed, narrowing the question to whether the statutory phrase requires payment of transportation costs.
- The Oregon Supreme Court reviewed whether "expenses of medical
- services" under ORS 742.524(1)(a) includes non-ambulance transportation costs to obtain medical care.
- The statute lists specific covered items (medical, hospital, dental, surgical, ambulance, prosthetic services), contains a presumption favoring provider-submitted claims, and (as of the 2007 text at issue) capped aggregate medical PIP benefits and limited the covered time period.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ORS 742.524(1)(a) "expenses of medical * services" requires insurers to pay transportation costs (other than ambulance) to obtain medical care | Dowell: "expenses" and the Insurance Code's directive to liberally construe insurance statutes mean "expenses of medical services" covers costs to obtain care (including travel); policy purpose (prompt payment, reduce litigation) supports inclusion | Oregon Mutual: text and context limit coverage to services supplied by licensed health-care providers; statute expressly includes ambulance but not ordinary transportation, and provider-presumption indicates focus on provider-rendered services | Court held transportation costs (other than ambulance) are not PIP medical benefits under ORS 742.524(1)(a); affirmed Court of Appeals and trial court |
Key Cases Cited
- PGE v. Bureau of Labor & Indus., 317 Or. 606 (Oregon Supreme Court) (governs statutory interpretation framework)
- State v. Gaines, 346 Or. 160 (Oregon Supreme Court) (statutory construction principles)
- Dowell v. Oregon Mut. Ins. Co., 268 Or. App. 672 (Or. Ct. App.) (Court of Appeals decision framing the question and prior analysis)
- Perez v. State Farm Mut. Ins. Co., 289 Or. 295 (Oregon Supreme Court) (describing PIP purpose as prompt reimbursement for some out-of-pocket losses)
- Ivanov v. Farmers Ins. Co., 344 Or. 421 (Oregon Supreme Court) (application of the provider "reasonable and necessary" presumption)
- Malu v. Security Nat'l Ins. Co., 898 So. 2d 69 (Fla. 2005) (Florida Supreme Court holding travel costs reimbursable under Florida PIP statute; relied on liberal remedial purpose)
- Allstate Ins. Co. v. Smith, 902 P.2d 1386 (Colo. 1995) (Colorado Supreme Court holding mileage to/from providers compensable under Colorado PIP statute; emphasized remedial/maximizing coverage policy)