20 Fla. L. Weekly Supp. 1002b
Online Reference: FLWSUPP 2010BRUNInsurance — Personal injury protection — Discovery — Reasons why individual bills were not paid at 80% or 100%, name and address of person employed by insurer who has most knowledge of why each individual bill was not paid at 80%or 100%, and name and address of each person who will testify at trial as to why each individual was not paid at 80% or 100% — Range of charges submitted by all providers in particular zip for certain CPT codes — Motion to compel better answers granted
PERSONAL CHIROPRACTIC CARE CENTER, INC. (A/A/O MARTINE BRUNY), Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 12-011791 COSO 60. July 25, 2013. Honorable Ian Richards, Judge. Counsel: Rafael Katz, Katz & Katz, P.A., Hollywood, for Plaintiff. Jenna Selsky, Goldstein Law Group, Fort Lauderdale, for Defendant.
ORDER ON PLAINTIFF’S MOTION TO COMPELBETTER ANSWERS TO INTERROGATORIES
THIS CAUSE having come before the Court for hearing on April 25, 2013, and the Court having been advised of the agreement of counsel for the respective parties regarding interrogatories 6, 7 and 9 and having heard argument of counsel regarding interrogatories 5 and 11 and being otherwise fully advised in the premises, it is:
ORDERED and ADJUDGED:
1. The parties have agreed that Defendant will provide better answers to Plaintiff’s interrogatories number 6, 7 and 9.
2. The Court heard argument of counsel regarding Interrogatories 5 and 11.
3. In Interrogatory number 5, Plaintiff asked:
“If any of the medical expenses/bills received by the Defendant were not paid at 80% (or 100% if the policy includes med pay), please prepare a break down for each bill as follows:
a) the specific reasons why each individual bill was not paid at 80% or 100%; (If the Defendant responds by stating see the explanations of benefits forms then the Plaintiff will assume all other defenses not contained in the EOBs are deemed waived);
b) the specific formula or criteria used by the insurer in determining the amount which was paid for each individual bill.
c) the name and address of the person employed, directly or indirectly, by the Defendant who has most knowledge as to why each individual bill was not paid at 80% or 100%, together with a listing of their credentials, including education, professional experience, and licensing; and
d) the name and address of each person who will testify at the time of trial why each individual bill was not paid at 80% or 100%. If unknown at this time please state when the Defendant will have this information.”
4. In response to Interrogatory number 5, Defendant stated:
“a. Objection. This interrogatory is vague, ambiguous, seeks to invade Defendant’s work product and attorney-client privilege and otherwise seeks to shift the burden of proof from Plaintiff to the Defendant relative to the reasonableness, relatedness or necessity of the charges submitted for reimbursement. There is nothing in this personal injury protection (PIP) statute suggesting a legislative intent to alter the normal dynamics of a lawsuit by placing the burden on the defendant in a PIP case to prove that a proposed charge was unreasonable or that a given service was not necessary. Subject o and without waiving the foregoing objections, please refer to all relevant, non-privileged portions of the subject claim file, including but not limited to all claim forms submitted by Plaintiff, Explanation of Benefits provided to Plaintiff by Defendant, and all correspondence between Plaintiff and Defendant, which were provided in response to Plaintiff’s Request for Production.
b. Objection. This interrogatory is vague, ambiguous, seeks to invade Defendant’s work product and attorney-client privilege and otherwise seeks to shift the burden of proof from Plaintiff to the Defendant relative to the reasonableness, relatedness or necessity of the charge submitted for reimbursement. There is nothing in this personal injury protection (PIP) statute suggesting legislative intent to alter the normal dynamics of a lawsuit by placing the burden on the defendant in a PIP case to prove that a proposed charge was unreasonable or that a given service was not necessary. Furthermore, Plaintiff has failed to lay the proper foundation for this request as Defendant’s policies and procedures are not discoverable in an action for PIP benefits. Moreover, Plaintiff seeks confidential business/trade secrets and proprietary/copyrighted information, which is neither relevant nor reasonably calculated to lead to the discovery of admissible evidence in this action. Subject to and without waiving the foregoing objections, the Defendant paid an appropriate and an allowable amount to the Plaintiff pursuant to the terms, conditions, limitations, and exclusions of the subject policy of insurance under which the instant claim is made, as well as Fla. Stat. §627.736(5)(a)1, which provides that: With respect to a determination of whether a charge for a particular service, treatment, or otherwise is reasonable, consideration may be given to evidence of usual and customary charges and payments accepted by the provider involved in the dispute, and reimbursement levels in the community and various federal and state medical fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service, treatment, or supply. With regard to all bills at issue which were neither paid nor reduced, but were denied pursuant to the results of an Independent Medical Examination and/or Peer Review, please refer to the report(s) produced in response to Plaintiff’s Request for Production.
c. Objection. This interrogatory is vague; ambiguous; overly broad; seeks information which is neither relevant to the issues as framed by the pleadings nor reasonably calculated to lead to the discovery of admissible evidence and otherwise seeks to invade the individuals Constitutional Right to Privacy. Moreover, Plaintiff has failed to lay the proper foundation for this request as Defendant’s policies and procedures are not discoverable in an action for PIP benefits. Subject to and without waiving the foregoing objections, the persons or adjusters that were involved with the handling of this claim were as follows:
Nichole Richeson
State Farm Insurance Company
P.O. Box 9606
Winterhaven, FL 33883
Chris Chandler
Claims Handler
P.O.Box 9608
Winterhaven, FL 33883
d. Objection. This interrogatory is premature as Defendant has not yet determined who will testify at the time of trial. Subject to and without waiving the foregoing objections, Defendant will disclose the names and addresses of all witnesses it intends to call to trial in accordance with the Court’s Trial Order.”
5. In Interrogatory number 11, Plaintiff asked:
“For the time period within which the medical services that are the subject of this lawsuit were rendered, for each CPT Code listed below, please list the range of charges submitted by all provider in geozip 331 and please list the mean, the median and the modal charge for each CPT Code listed below.
99204 25, 72100, 72040, 72020, 98942, 97012 59, 97140 59, 97010, 99213 25, 97530, 97112, 98941, 97535, 99214 25.”
6. In response to Interrogatory number 11, Defendant stated:
“Objection. This interrogatory is vague, ambiguous, overbroad, unduly burdensome, harassing and seeks information which is irrelevant and not reasonably calculated to lead to the discovery of admissible evidence. Additionally, this request seeks to shift the burden of proof from Plaintiff to the Defendant relative to the reasonableness of die charges submitted for reimbursement. There is nothing in this personal injury protection (PIP) statute suggesting a legislative intent to alter the normal dynamics of a lawsuit by placing the burden on the defendant in a PIP case to prove that a proposed charge was unreasonable or that a given service was not necessary.”
7. Plaintiff’s Motion to Compel Better Answers to the above interrogatories is GRANTED.
8. Defendant shall provide better responses to Plaintiff’s Interrogatories numbered 5, 6, 7, 9, and 11within 30 days of April 26, 2013.
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