22 Fla. L. Weekly Supp. 113a
Online Reference: FLWSUPP 2201SELOInsurance — Personal injury protection — Discovery — Depositions — Order establishing scope of deposition of insurer’s corporate representative and materials representative is required to bring to deposition
COASTAL NEUROLOGY, INC., as assignee of Susan Selover, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 7th Seventh Judicial Circuit in and for Volusia County. Case No. 2013 31684 COCI, Division 84. February 5, 2014. Dawn P. Fields, Judge. Counsel: William England, Bradford Cederberg, P.A., Orlando, for Plaintiff. C. Jason Grundorf, Orlando, for Defendant.
ORDER ON PLAINTIFF’S MOTION TO COMPELTHE DEPOSITION OF DEFENDANT’SCORPORATE REPRESENTATIVE
THIS MATTER having come before this Honorable Court on 12/4/2013 on Plaintiff’s Motion to Compel Deposition of Defendant’s Corporate Representative and this Honorable Court having heard arguments of counsel and being otherwise fully 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. Pursuant to Florida Rule of Civil Procedure 1.310(b)(6), the scope of the deposition is attached as Exhibit “A.”
2. The deposition of Defendant’s Corporate Representative shall be scheduled no later than sixty (60) days from the date of this Order to occur no later than one hundred and twenty (120) days from this Order.
3. Defendant does not waive any objections it may wish to assert.
EXHIBIT “A”
1. State Farm’s methodology to determine whether Plaintiff’s charges were a reasonable amount.
2. State Farm’s methodology to determine what a reasonable amount for the services at issue are and the supporting basis.
3. The information considered by State Farm in determining whether the Plaintiff’s bill for the services rendered were reasonable in price.
4. The maximum charge that would be reasonable as determined by State Farm, at the time of service, for the services at issue in this case.
5. 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.
6. 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.
7. 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.
8. Processing and payment or non-payment of other medical providers’ bills represented on the PIP/Medical Payment log or payout sheet for the CPT Codes at issue rendered to the insured/assignor.
9. Defendant’s reimbursement amount for the medical services provided by Plaintiff to the assignor in this matter for the CPT Codes at issue.
10. Any information, documentation, and/or authority relied upon by Defendant that indicates in anyway it can reimburse Plaintiff pursuant to “200% of the Participating Level of Medicare Part B fee schedule.”
11. Any information, documentation, and/or authority relied upon by Defendant surrounding the reasonableness of Plaintiff’s charges in this matter.
12. The factual bases for any and all affirmative defenses asserted by Defendant in this matter.
13. The factual bases behind Defendant’s explanation code/explanation of payment as listed on the Explanation of Benefits/Explanation of Review form(s) for Plaintiff’s bill at issue in this matter.
14. Reports/charts/audits to which Defendant is privy as it relates to amounts charged by other medical providers in the 32XXX geo zip (Volusia County) for the CPT codes/charges at issue for six (6) months before the date of service at issue in this case and for six (6) months after the date of service at issue in this case.
The Defendant’s Corporate Representative is to have with him/her the following items. If Defendant asserts that some of the documents are privileged, then the documents shall be attached to the deposition under seal and submitted to the Court with a privilege log for an in camera inspection:
1. A copy of the claim file referenced in the Plaintiff’s Complaint/Amended Complaint for the assignor in this case.
2. Any and all correspondence, documents, materials or other items which are in your possession regarding the medical reports and bills received from the Plaintiff related to treatment provided to the assignor in this case.
3. Any and all correspondence, documents, materials or other items which are in your possession regarding the medical reports and bills received from the undersigned related to treatment provided by the Plaintiff to the assignor in this case.
4. To the extent that they exist, any and all Independent Medical Examination (hereinafter “IME”) requests and IME reports related to the assignor in this case.
5. To the extent that they exist, any and all Examinations Under Oath (hereinafter “EUO”) requests and EUO transcripts related to the assignor in this case or the automobile accident that the assignor was involved in which is at issue in this case.
6. To the extent that they exist, any and all reports or medical opinions or records review conducted in this manner in connection with the treatment provided by the Plaintiff to the assignor in this case.
7. To the extent that they exist, any and all PIP forms, including PIP Applications, medical report forms, employer verification forms, authorization forms and any other forms contained in the assignor’s file.
8. To the extent that they exist, any and all correspondence from State Farm to any doctors or medical providers, or vise versa, related to any Independent Medical Examinations “IMEs” or paper/peer review reports related to the assignor in this case.
9. To the extent that they exist, any and all correspondence related to or from State Farm including agencies who were hired to schedule an Examination Under Oath “EUO” related to the assignor in this case who were in attendance at the time of the set “EUO”.
10. Any and all correspondence related to the assignor in this case from the Plaintiff, the insured, the treating physicians, healthcare providers or BRADFORD CEDERBERG, P.A., including original documents so that any date stamps may be seen.
11. A copy of any and all checks to Plaintiff, including explanation of benefits, related to treatment provided to the assignor in this case.
12. An up-to-date PIP Payout Sheet/PIP Log for the assignor in this case.
13. To the extent that they exist, statistical surveys of healthcare providers, mathematical calculations or data that Defendant relies upon to reduce the charges in this case or support its allegation that Plaintiff’s charges for the CPT Codes at issue are not reasonable, including health care providers surveyed for the CPT codes relevant in this case and the percentile of reimbursement utilized by defendant.
14. A copy of the Notification of Insured’s Rights as required by Fla. Stat. §627.7401 delivered by the Defendant to the assignor in the caption of this lawsuit, including, but not limited to: copies of any cover letter(s) or other correspondence accompanying the Notice, the Notice itself, a copy of the envelope that included the Notice and copies of any and all documents, papers, or other forms or letters included with the Notice to the assignor.
15. A copy of any and all executed agreements/contracts between Defendant (and any of its entities) and Mitchell Medical, Mitchell International and/or any other third party auditing vendor if utilized for the claim at issue and in effect when Plaintiff’s bill at issue was processed.
16. If it exists in any form, a chart or report reflecting what other medical providers of neurologic evaluation services charged in the same year that Plaintiff performed its diagnostic evaluation for the same CPT code within geo zip 32XXX (Volusia County) for six (6) months before the subject treatment was rendered in this case and six (6) months after. The chart or report needs to include the name of the diagnostic/neurological medical provider, the address of the neurologic testing medical provider and the amount charged for the CPT codes at issue.
17. If it exists in any form, a chart or report reflecting what other medical providers of neurologic evaluation services charged for the 70th percentile, 75th percentile, 80th percentile, 85th percentile, 90th percentile and 95th percentile for geo zip 32XXX (Volusia County) for the CPT code/charge at issue for six (6) months before the date of service at issue in this case and for six (6) months after the date of service at issue in this case.
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