12 Fla. L. Weekly Supp. 1094a
Insurance — Personal injury protection — Discovery — Insurer’s claims representative is required to produce at deposition all relevant policies, adjuster computer entries, and notes in PIP file up until date adversarial process began, entire PIP file, documentation regarding proper procedure for reviewing PIP claims or for handling and resolving PIP claims, any correspondence or reports received regarding insured’s medical condition, informational bulletins relied on in calculation of claim, and any surveillance reports or other investigative reports with regard to insured
ROYAL PALM BEACH MEDICAL, INC., (Opal Gayle, Patient), Plaintiff, vs. ALLSTATE INSURANCE COMPANY, Defendant. County Court, 15th Judicial Circuit in and for Palm Beach County. Case No. 502005SC002769XXXXMBRB. July 27, 2005. Joseph Marx, Judge. Counsel: Cindy A. Goldstein, George & Peduzzi, P.A., West Palm Beach. Joseph Murasko and Sheri Hopkins, Vernis & Bowling, P.A., North Palm Beach.
ORDER ON DEFENDANT’S MOTION FOR PROTECTIVE ORDER AS TO DUCES TECUM ITEMS OF CLAIM REPRESENTATIVE DEPOSITION
THIS CAUSE having come before this Honorable Court on Defendant’s Motion for Protective Order As To Duces Tecum Items of Claim Representative Deposition, and based upon the argument of counsel and the Court being otherwise advised in the premise, it is hereby
ORDERED AND ADJUDGED:
1. Defendant’s objection to item #1 is overruled. Defendant is required to produce at the deposition all relevant insurance policies that would inure to the benefit of the Plaintiff herein, together with any declaration statements.
2. Defendant’s objection to item #2 is overruled. Defendant is required to produce at the deposition all adjuster computer entries and notes in the Plaintiff’s PIP claim in existence up until the above-styled adversarial process began.
3. Defendant’s objection to item #3 is overruled. Defendant is required to produce at the deposition “[t]he entire PIP file maintained by you or any one on your behalf with regard to the Plaintiff’s patient, Opal Gayle, cover to cover, including the original jackets and everything contained within the file, including, without limitation, all notations regarding notice of the accident, or telephone messages to you, or any of your agents on your behalf, all accident reports, all interoffice memoranda, all correspondence to or from anyone, including any insurance agencies, any doctor’s offices, any employers, and any agencies hired to select doctors for “independent medical examinations,” and any and all PIP forms including the PIP application, medical report forms, employer verification forms, authorization forms and any other forms contained in said file.”
4. Defendant’s objection to item #4 is overruled. Defendant is required to produce at the deposition any documents, memos, correspondence, booklets, computer entries, or pamphlets of any kind that relate to instructions or guidelines for the proper procedure for reviewing insurance PIP claim bills or files, reviewing second opinion medical examinations or determining whether to terminate or reduce payments of an insured’s medical bills as it would apply to any of the adjusters reviewing, reducing, or terminating the Plaintiff’s payments of medical bills in the present case.
5. Defendant’s objection to item #5 is overruled. Defendant is required to produce at the deposition copies of any and all leaflets, brochures, programs, telegrams, memoranda, correspondence, documents, warnings, or other policies disseminated by you or any of your agents, employers and/or representatives for the three (3) years prior to the filing of this lawsuit, setting forth procedures, comments, suggestions, guidelines, or criteria for the handling, adjusting investigating, resolving, or settling of PIP claims.
6. Defendant’s objection to item #10 is overruled. Defendant is required to produce at the deposition “[c]opy of any and all forms, correspondence, reports received by you or any of your agents on your behalf concerning the Plaintiff’s medical condition from anyone.”
7. Defendant’s objection to item #13 is overruled. Defendant is required to produce at the deposition “[a]ny and all informational bulletins relied on in calculation of this claim, received by you from the Florida Department of Insurance concerning the handling of PIP claims for the three (3) years prior to the filing of this lawsuit.”
8. Defendant’s objection to item #14 is overruled. Defendant is required to produce at the deposition “[a]ny and all surveillance reports, claims history reports or other investigative report prepared by you or on your behalf with regard to the Plaintiff.”
9. Items #6, 7, 8, 17 have been withdrawn by Plaintiff.
10. Defendant’s objection to item #9 is granted.
11. Items # 12, 15, 16, 18, and 19 are not challenged by the Defendant and therefore are required to be produced.1
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1Item #12: “All correspondence, forms, notations, memoranda or information transmitted by you in any form whatsoever to any physician’s office or health care provider’s office concerning the Plaintiff’s patient’s physical and/or mental condition.”
Item #15: Any and all documents setting forth the Defendant’s written consent to any assignment made by the insured of any coverage or benefits available within the Defendant’s insurance policy with the insured Plaintiff.
Item #16: “Please provide your “paid-for” medical examiner’s taxpayer identification number and copies of any and all 1099 forms concerning said physician.”
Item #18: In the event a “paid-for” examiner was used by the Defendant, provide the following:
a. All 2nd opinion reports generated by the Defendant’s “paid-for” examiner within the past three (3) years.
b. All Independent/Compulsive Medical Examinations reports produced by any doctor selected by the third-party vendor for Allstate Insurance Company in Palm Beach County for the past three (3) years. (Please block out any patient names for privacy concerns.)
c. Any and all documents, correspondence, brochures or writings of any kind between the third-party vendor and Allstate Insurance Company for the past three (3) years concerning sales, solicitation, services provided, procedures or guidelines to be used in selecting independent/compulsive medical examiners.
d. Any and all documents, correspondence, brochures or writings of any kind between the third-party vendor and Allstate Insurance Company for the past three (3) years in relation to receiving assignments for independent medical examinations and procedures or guidelines used for said assignments and choosing said medical examiners.
e. Any and all documents, correspondence, brochures or writings of any kind between the third-party vendor and Allstate Insurance Company for the past three (3) years when investigating medical examiners being used for independent/compulsive medical examinations.
f. Contracts between the third-party vendor and Allstate Insurance Company or any other document relating to general operating principles outlining or delineating the business relationship between the third-party vendor and Allstate Insurance Company.
g. All internal policy and procedure manuals in regard to hiring of compulsive examination physicians, investigation for compulsive examinations physicians and reporting on compulsive examination physicians.
h. All memorandums, correspondence, outlines or documents of any kind that set forth policies and procedures your company has to make sure physicians hired are fair, objective, honest and not biased.
I. Any and all documents of any kind setting forth investigatory procedures used to review reports done by physicians hired to ensure accuracy, objectiveness and unbiased reporting of a patient’s medical condition.
j. Any and all documents regarding the computer system or database utilized to review the medical bills in issue, including but not limited to:
– All documents setting forth the geographic scope of the database used;
– All documents setting forth the professional scope of the database used;
– All documents setting forth the time scope of the database used;
– All documents setting forth how much the review services was compensated;
– All documents setting forth any contracts between the Defendant and the vendor providing the review services.
Item #19: In the event the Defendant has adjusted, reduced or failed to pay in its entirety any bill of the Plaintiff, produce any and all documents, brochures, pamphlets, computer programs, data bases, data, or information of any kind relied on by the Defendant, if the Defendant intends on using the data base or information in any way for the defense of its case.
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