12 Fla. L. Weekly Supp. 565a
Insurance — Personal injury protection — Discovery — Documents — Insurer is entitled to all documentation in medical provider’s possession that evidences treatment performed; that treatment was reasonable, related and medically necessary; and reasonableness of charges, including information regarding amounts provider accepts from patients and entities other than insurer
FLORIDA SPINE CARE AND PAIN CENTER, (as assignee for Randy Yarbrough), Plaintiff, v. PROGRESSIVE EXPRESS INSURANCE COMPANY, Defendant. County Court, 4th Judicial Circuit in and for Duval County. Case No. 2004-CC-004264, Division J. January 31, 2005. Eleni E. Derke, Judge. Counsel: Earl I. Higgs, Morgan, Colling & Gilbert, P.A., Orlando, for Plaintiff. Christopher K. Leifer, James C. Rinaman, III & Associates, P.A., Jacksonville, for Defendant.
ORDER ON DEFENDANT’S MOTION TO COMPEL BETTER RESPONSES TO DEFENDANT’S REQUEST FOR PRODUCTION
THIS CAUSE, having come before the Court on Defendant’s Motion to Compel Better Answers to Defendant’s First Interrogatories, and after hearing argument of counsel and being otherwise fully advised in the premises, it is:
ORDERED AND ADJUDGED:
1. Paragraph 4 of Plaintiff’s Complaint alleges that the case sub judice is “. . . the direct and proximate result of the personal injuries the Insured sustained in the accident. . .” and that “the Insured incurred expenses for reasonable, related and necessary medical and rehabilitative treatment and therapy . . . performed or provided by Plaintiff.”
2. Paragraph 12 of Plaintiff’s Complaint alleges that the Defendant has failed to “pay PIP benefits in accordance with Florida law . . . .” Specifically, Plaintiff is disputing the reductions made to Plaintiff’s charges.
3. Defendant’s Request for Production, numbered 1C, 1D, 1F, 5 and 10, are requests for medical records and documentation related to services allegedly rendered to Randy Yarbrough, by Plaintiff, as follows:
A. Request 1C seeks “diagnostic tests, data reports, including, but not limited to, tests tracing data reports for diagnostic procedures such as MRI, EMG, EEG, EKG, CT Scan, Brain Scan Invoked Response, Myelogram, nerve conduction, etc.”
B. Request 1D seeks “X-Rays and/or reports of X-Rays.”
C. Request 1F seeks “any and all documents evidencing proof of mailing medical records and bills to Progressive for medical services rendered.”
D. Request 5 seeks “Copies of licenses and/or certifications for any persons performing any therapy, medical services, and/or diagnostic testing including interpreting diagnostic tests.”
E. Request 10 seeks “Any and all patient sign in/out sheets, intake forms or patient questionnaires completed and/or signed by Randy Yarbrough.”
4. Defendant’s Requests for Production number 1G, 6, 7 and 8 are requests for records and other documentation, from Plaintiff, related to the charges for and payment of medical services allegedly rendered to Randy Yarbrough by Plaintiff as follows:
A. Request 1G seeks “any and all documents evidencing proof of mailing medical records and bills to Progressive for medical services rendered.”
B. Request 6 seeks “Any documents reflecting a schedule of fees customarily charged by [Plaintiff] for CPT codes 99213, 97032 and 97140, for services rendered to any class of patient, including, but not limited to, workers compensation patients, patients paying cash, patients belonging to a PPO, patients belonging to an HMO, uninsured patients, etc., in the year 2003.”
C. Request 7 seeks “Any documents reflecting a schedule of fees accepted for payment by [Plaintiff] for CPT codes 99213, 97032 and 97140, for services rendered to any class of patient, including but not limited to, workers compensation patients, patients paying cash, patients belonging to a PPO, patients belonging to an HMO, uninsured patients, etc., in the year 2003.”
D. Request 8 seeks “A copy of any fee analysis materials, including but not limited to, ‘Medicode’ or other similar publications, utilized by Plaintiff to determine the billing amount for CPT codes 99213, 97032 and 97140 for the year 2003.”
5. Defendant is entitled to all documentation in Plaintiff’s possession that evidences the alleged treatment performed or provided by Plaintiff, as well as evidence that said treatment was reasonable, related and medically necessary.
6. Defendant is entitled to all documentation in Plaintiff’s possession, if any, that evidences the reasonableness of the charges for the alleged treatment performed or provided by Plaintiff, including information regarding the amounts that Plaintiff charges to, or accepts from, patients and entities other than Defendant.
7. Defendant’s Motion to Compel Better Responses to Defendant’s First Request for Production is hereby GRANTED.
8. Plaintiff shall provide better Responses within 30 days.
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