21 Fla. L. Weekly Supp. 685b
Online Reference: FLWSUPP 2107CROFInsurance — Personal injury protection — Discovery — Depositions — Insurer is ordered to produce its corporate representative for deposition, and scope of deposition is defined
FLORIDA HOSPITAL MEDICAL CENTER, as assignee of Morgan Crofton, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2013-SC-5301-O. March 26, 2014. Andrew L. Cameron, Judge. Counsel: William England, Bradford Cederberg, P.A., Orlando, for Plaintiff. John Morrow, Orlando, for Defendant.
ORDER
THIS MATTER having come before this Honorable Court on February 19, 2014, on Defendant, State Farm Mutual Automobile Insurance Company’s (“State Farm”) Motion for Protective Order and Plaintiff’s Motion to Compel Deposition and the Court having heard argument of counsel, and being otherwise advised in the premises, it is hereby,
ORDERED AND ADJUDGED that:
1. Plaintiff’s Motion to Compel the Deposition of Defendant’s Corporate Representative is GRANTED.
2. State Farm’s Motion for Protective Order is DENIED. State Farm shall produce its Corporate Representative for deposition, pursuant to Florida Rule of Civil Procedure 1.310(b)(6), the scope of the deposition is limited to the areas of inquiry specified in Exhibit “A.”Exhibit A
1. State Farm’s methodology to determine whether Plaintiff’s charges were a reasonable amount, and the supporting basis.
2. State Farm’s precise methodology to determine what a reasonable amount for the Plaintiff’s services at issue are and the supporting basis, including facts and data.
3. The information considered by State Farm in determining whether the Plaintiff’s bill for the services rendered were reasonable in price.
4. The relationship between State Farm and Mitchell International, Inc. in the processing and/or auditing of medical bills for State Farm policyholders.
5. Whether State Farm based its reimbursement at issue on Plaintiff’s usual and customary charges.
6. The position that the charges for the services rendered by the Plaintiff are not reasonable in price, the basis for that position and any evidence to support that position.
7. The maximum charge that would be reasonable as determined by State Farm for the services at issue in this case.
8. The “auto pay” process utilized by State Farm for the payment of medical bills.
9. The position that the services rendered by the Plaintiff in this matter to the insured, are not reasonable, the basis for that position and any evidence to support that position.
10. The position that the services rendered by the Plaintiff in this matter to the insured, are not related to the motor vehicle accident, the basis for that position and any evidence to support that position.
11. The position that the services rendered by the Plaintiff in this matter to the insured, are not medically necessary, the basis for that position and any evidence to support that position.
12. All of State Farm’s Affirmative Defenses and the supporting basis, including facts, data, policy language of the policy of insurance at issue, statutory language, and case law.
13. Any and all instances where State Farm provided its insured or Plaintiff notice of its intent to limit reimbursement to a percentage of 75% of Plaintiff’s usual and customary charge, prior to or on the date of service at issue.
14. Inquiry regarding any of the documents listed in the duces tecum included herein.The Defendant’s Corporate Representative isto have with him/her the following items.
1. A complete copy of the claim file referenced in the Plaintiff’s Complaint/Amended Complaint for the assignor in this case.
2. Any and all documentation relied upon by State Farm in its determination that the charges for the services at issue was not a reasonable charge.
3. Any and all information regarding statistical surveys of healthcare providers utilized by Defendant to reduce the charges in this case, including health care providers surveyed for the CPT codes relevant in this case and the percentile of reimbursement utilized by defendant.
4. Any and all documentation relied upon by State Farm in its determination that the services at issue were not related to the motor vehicle accident.
5. Any and all documentation relied upon by State Farm in its determination that the services at issue were not medically necessary.
6. Any and all documentation relied upon by State Farm in its determination that the services at issue were not reasonable.
7. Any information and/or documentation in Defendant’s possession surrounding any research and/or evaluation conducted by Defendant, or a third party on behalf of Defendant, of reimbursement levels in the community wherein the services in this matter were performed for the CPT Code(s) at issue.
8. Any review and/or examination, and the results thereof, of the reasonableness of the Plaintiff’s charges performed by Defendant, or a third party on behalf of Defendant, prior to the issuance of any EOBs/EORs for the CPT Code(s) at issue in this matter.
9. A chart reflecting what other hospitals as well as the Plaintiff charged in same year the Plaintiff performed the services in question for the same CPT code(s) within Orlando for 6 months before the services that were rendered in this case and 6 months after. The chart needs to include the name of the hospital(s), the address of the hospital(s) and the amount charged for the CPT codes at issue.
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