13 Fla. L. Weekly Supp. 1215b
Insurance — Personal injury protection — Discovery — Where insurer wants to dispute reasonableness of charges by relying on computer program and computer generated sums, medical provider is entitled to discovery of every explanation of benefits and explanation of reimbursement generated by insurer for CPT codes at issue in geozip for period three months prior to and three months after statement of particulars — Discovery request is burdensome, but not unduly burdensome since all information is or should be computerized and insurer has ability to have program designed to make accessing information less burdensome
GULF COAST INJURY CENTER, L.L.C., (a/a/o Seaford Jackson), Plaintiff, v. PROGRESSIVE AUTO PRO INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County, Small Claims Division. Case No. 05-17462, Division I. July 26, 2006. Charlotte W. Anderson, Judge. Counsel: Timothy A. Patrick, Nicholas, Lipscomb & Patrick, P.A., Tampa, for Plaintiff. Brian Crim, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION TO COMPEL BETTER RESPONSES
THIS CAUSE came before the Court on June 26, 2006 on Plaintiff’s Motion to Compel Better Responses to Plaintiff’s Second Request to Produce. Plaintiff’s counsel, Timothy A. Patrick, and Defendant’s counsel, Brian Crim were present. The court after hearing argument of counsel and having reviewed the record,
It is ORDERED and ADJUDGED as follows:
(1) Plaintiff’s Second Request to Produce requested the following:
Each and every explanation of benefit (EOB) and explanation of reimbursement (EOR) generated by the Defendant for the geozip 336__ for the time period of three (3) months prior to, and three (3) months subsequent to each of the respective dates of service and CPT codes at issue pursuant to the attached Statement of Particulars.
(2) Progressive objected to the production of these EOB’s and EOR’s.
(3) The court rules that if Progressive wants to dispute the reasonableness of charges by relying upon its computer program and computer generated sums, the Plaintiff is entitled to discover whether the computer assessment is indeed an objective and accurate assessment of the reasonableness of the charges.
(4) The court relies upon Allstate v. Hodges, WL 21946592 (Fla. 2nd DCA 2003). The court finds that the production of this information may be burdensome, but is not unduly burdensome. All of this information is, or should be, computerized. As the court said of Allstate, if this is too much trouble for the Defendant, Allstate may want to reconsider adapting its computer system to provide easier access to the requested information. This kind of information is requested from Progressive on a regular basis. Progressive knows it has the ability to have a program designed that would make it less burdensome. This information is exclusively within the possession and control. This case is certainly distinguishable from Madock (a/a/o Kus) v. Progressive, Hillsborough County (Appellate) Case No. 03-6538, Div. X, Lower Case No. 02-4680. [11 Fla. L. Weekly Supp. 408b]. In Madock, the court denied the admission of evidence from a payment from a non-party insurer. In this case, the EOB’s and EOR’s reflecting payment are only from this one insurer, Progressive.
(5) Progressive must produce each and every explanation of benefit (EOB) and explanation of reimbursement (EOR) generated by the Defendant for the geozip 336__ for CPT codes 99211, 97014, 97010 and 97124 for the time period of November 15, 2005 through March 15, 2006.
(6) Progressive may redact the claimant’s name or any information that would make the claimant identifiable in order to comply with the requirements of HIPPA. Progressive may redact hand written notes from the EOB’s, but may not redact the medical provider’s name.
(7) Progressive has sixty (60) days to produce this information to Plaintiff’s counsel.
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