A woman was insured under a motor vehicle insurance policy. As statutorily required, the woman’s insurance policy included personal injury protection coverage, which is Oregon’s version of no-fault motor vehicle insurance. Under the personal injury protection statutory scheme, when an insured is injured in a motor vehicle accident, regardless of fault, the insurer is required to pay certain expenses. These expenses include “expenses of medical … services.” ORS 742.524(l)(a).
The woman was injured in a motor vehicle accident. She applied for personal injury protection medical benefits, which her insurer paid. The woman also incurred $430.67 in expenses for transportation to attend medical appointments and to obtain medication. The insurer declined to pay those expenses.
The woman filed a complaint for breach of contract against the insurer. The complaint alleged that her claim for medical expenses included the expense of transportation to attend medical appointments and to obtain medication and that the insurer breached its contract by failing to reimburse her for those expenses. The insurer moved for summary judgment, arguing that Oregon’s personal injury protection statute did not require it to pay the woman’s transportation expenses. The Multnomah County Circuit Court entered summary judgment in favor of the insurer.
The Court of Appeals of Oregon affirmed. The court held that the statute requiring insurers to pay “expenses of medical ... services” did not include the expense of transportation to attend medical appointments and obtain medication.
The statute requiring insurers to pay “expenses of medical ... services” did not include the expense of transportation to attend medical appointments and obtain medication. The court looked to the dictionary definitions of each of the four words in dispute and found that plain meaning of “expenses of medical… services” was something that is expended to secure a benefit relating to work that is performed by another, when that work involves the practice of medicine (the maintenance of health, and the prevention, alleviation, or cure of disease). The court found that this construction was supported by the context of the entire statute. The court determined that the legislature did not intend the phrase “expenses of medical … services” to include the expense of transportation to obtain those services because the statute’s definition of “provider” excluded cabdrivers, bus drivers, or other persons were not authorized medical or mental health services providers who transport an insured to attend medical appointments or to obtain medication. Nor were payments required when an insured transported him or herself to attend medical appointments or obtain medication.
The Court of Appeals of Oregon affirmed the trial court’s entry of summary judgment in favor of the insurer.
See: Dowell v. Oregon Mut. Ins. Co., 2015 WL 363484 (Or.App., January 28, 2015) (not designated for publication).
See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication