Late last week, in Dowell v Oregon Mut. Ins. Co., 268 Or App 672, — P3d — (2015), the Oregon Court of Appeals analyzed Oregon’s  Personal Injury Protection (“PIP”) statute and addressed whether “expenses of medical … services” in ORS 742.524(1)(a) includes transportation expenses incurred while seeking covered medical services.  The court determined that the legislature did not contemplate that transportation expenses would be covered under the PIP statute.  Accordingly, the insured was entitled to payment for transportation expenses incurred while seeking medical treatment that was otherwise covered under the policy.

The insured was injured in a motor vehicle accident.  Following the accident, the insured applied for PIP benefits.  In addition to the medical costs incurred, the insured also made a claim for $430.67 in transportation expenses incurred to attend medical appointments and to obtain medication.  The insurance company denied this portion of her claim.  The insured then filed suit individually, and on behalf of those similarly situated individuals.  The insured’s suit was limited to a claim for breach of contract relating to the transportation expenses.  The insurance company moved for summary judgment on the insured’s claim, arguing that ORS 742.524(1)(a) did not require it to pay plaintiff’s transportation expenses because they were not incurred by a medical provider.  The trial court granted the insurance company’s motion for summary judgment.  Plaintiff appealed.

The Court of Appeals analyzed the entire context of ORS 742.524(1)(a), including the dictionary definitions of the disputed terms, “expenses of medical … services.”   It also consulted how the disputed terms were used in other sections of the PIP statute.  Based on the definitions and use throughout the remaining provisions of the PIP statute, the court concluded that the legislature did not intend the phrase “expenses of medical … services” to include the expense of transportation to obtain those services.  The Court went on to state that ORS 742.524(1)(a) not only lists the services that an insurer is required to cover, but also contemplates that those services will be provided by a “provider.”  The Court held that the term “provider,” as used in ORS 742.524(1)(a) can only mean a person who is licensed, certified, or otherwise authorized to administer medical or mental health services—in other words, an authorized medical or mental health services provider. See ORS 742.518(10); ORS 743.801(13).  Based on that limitation, the Court held that there is no PIP coverage for expenses of services provided by cab drivers, bus drivers, or other persons who are not authorized medical or mental health services providers who transport an insured to attend medical appointments or to obtain medication.

The attorneys at Maloney Lauersdorf Reiner frequently represent clients facing issues regarding Personal Injury Protection (PIP) and insurance coverage related matters.  Please contact us with any questions concerning this case or any other matter you see addressed on the Insurance Coverage Blog.