22 Fla. L. Weekly Supp. 958a

Online Reference: FLWSUPP 2208PUERInsurance — Personal injury protection — Discovery — Depositions — Corporate representative of insurer — Scope of inquiry

DR. ROBERT S. SCHWARTZ, P.A. (A/A/O PUERTO, JUAN), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 2012 20295 COCE 56. March 6, 2015. Linda R. Pratt, Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff. Lisa S. Lullove, Roig Lawyers, Deerfield Beach, for Defendant.

ORDER ON DEFENDANT’S MOTIONFOR PROTECTIVE ORDER

THIS CAUSE having come before the Court on February 23, 2015 upon the motion of the Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY (“STATE FARM”), for a protective order as to the Notice of Taking Fla.R.Civ.P. 1.310(b)(6) deposition of STATE FARM, scheduling the deposition for March 11, 2015, and the Court having considered the motion, having heard argument of counsel and being otherwise fully advised, it is hereupon

ORDERED as follows:

1. Plaintiff DR. ROBERT S. SCHWARTZ, P.A. (a/a/o Puerto, Juan) shall be entitled to conduct the deposition of STATE FARM’s designated corporate representative and conduct inquiry regarding the following designated topics:

· General information of the Claim.

· Policy and coverage details of the Claim.

· The determination to pay the Claim at a reduced rate or otherwise refuse payment of services billed by Plaintiff for the Claim.

· The content of any data regarding the usual and customary charges and payments accepted by the Plaintiff.

· Whether the amount Plaintiff charged for performing CPT procedure codes 72052, 72110, 97010, 97012, 97016, 97035, 97110, 97112, 97124, 97140, 98940, 99202 and G0283 (the “Relevant CPT Code Procedures”) was unreasonable and the basis, including any underlying data and data compilations, analysis, spreadsheet(s), formula(s), average(s), survey(s), research, information and investigation to support that determination.

· Whether the amount Plaintiff charged for performing the Relevant CPT Code Procedures was not usual or customary, and the basis, including any underlying data and data compilations, analysis, spreadsheet(s), formula(s), average(s), survey(s), research, information and investigation to support that determination.

· Other than the Medicare Fee schedule and calculations contained in Sec. 627.736(5)(a)(2), Fla. Stat., all data or data compilations, analysis or analyses, spreadsheet(s), formula(s), average(s), survey(s), research, information, investigation(s) upon which Defendant has relied to dispute the reasonableness of the amounts charged by Plaintiff for performing the Relevant CPT Code Procedures.

· All items that were considered by the Defendant in determining the reasonableness of Plaintiff’s charges and how each of these items was utilized by the Defendant in calculating the reimbursement amounts.

· The method/methodology and calculations utilized in reducing the Plaintiff’s charges in this case to the allowed amount indicated in any Explanations of Review or Explanations of Benefits.

· The amounts charged by medical providers in the Community (defined as the same 330XX Geo Zip where the Plaintiff provided the medical services to Juan Puerto) who practice in the same specialty area as the Plaintiff, for the Relevant CPT Code Procedures, during the period of time from May 16, 2008 through February 6, 2009 (the “Relevant Period”).

· The amounts allowed by the Defendant for the charges of medical providers in the Community who practice in the same specialty area as the Plaintiff, for the Relevant CPT Code Procedures performed during the Relevant Period.

· Reports/charts/audits to which Defendant is privy as it relates to amounts charged by medical providers in the Community who practice in the same specialty area as the Plaintiff, for the Relevant CPT Code Procedures performed during the Relevant Period.

· The factual basis supporting the position that the Plaintiff did not charge a reasonable price for the medical services rendered to the Patient, including any evidence to support that position.

· If Defendant contends that the medical services rendered by the Plaintiff to the Patient was not related to the July 12, 2008 Automobile Accident, the factual basis supporting that position, including any evidence to support that position.

· If Defendant contends that the medical services rendered by the Plaintiff to the Patient was not medically necessary, the factual basis supporting that position, including any evidence to support that position.

· If Defendant contends that the medical services rendered by the Plaintiff to the Patient was not medically necessary or not related to the July 12, 2008 Automobile Accident, all information and documentation in Defendant’s care, custody, control or possession, which pertains, refers or relates to the July 12, 2008 Automobile Accident, including but not limited to medical records and invoices from other medical providers, accident reports, damage estimates, invoices and repair bills, photographs, statements and transcripts of Examinations Under Oath.

· The factual basis supporting each and every defense to payment asserted by Defendant as to the Claim.

2. Two business days in advance of the deposition, STATE FARM shall produce a Geo Zip report using Decision Point Software or similar software, reflecting the following information:

· identification of chiropractors and chiropractic facilities located within the Community, who have performed the Relevant CPT Code Procedures during the period of time from May 16, 2008 through February 6, 2009 (the “Relevant Period”) and who have billed STATE FARM for those procedures;

· the amounts charged by chiropractors and chiropractic facilities within the Community, for performing the Relevant CPT Code Procedures during the Relevant Period;

· the amounts allowed by STATE FARM as reasonable, approved or authorized charges for the Relevant CPT Code Procedures performed by chiropractors and chiropractic facilities within the Community, performed during the Relevant Period; and

· the amounts paid by STATE FARM to chiropractors and chiropractic facilities located within the Community, for the Relevant CPT Code Procedures, performed during the Relevant Period.

3. STATE FARM shall produce the following documents at the deposition:

· The entire Personal Injury Protection (PIP) claim file (pre-litigation and post-litigation) maintained by Defendant, including but not limited to: any notes/records reflecting Defendant’s review of the Claim; copies of any and all checks to Plaintiff; explanation(s) of benefits/review related to Plaintiff’s medical services rendered to the Patient; Defendant’s most up-to-date PIP payout sheet, record of payment or other form showing all bills that have been submitted for payment (whether showing bills paid in full or paid at reduced rates) and documenting when payments were made of PIP benefits on the Claim, including any computerized records; each and every letter, communication or correspondence in which Defendant notified Plaintiff of its failure to comply with any statutorily or contractually imposed conditions precedent to payment or suit; any and all responses by Defendant to Plaintiff’s demand letter(s); and actions taken by Defendant on the Claim. STATE FARM shall not waive any privilege by referring to any materials that are part of the PIP claim file in answering any questions at deposition. Any materials that are not produced under a claim of privilege shall be identified in an appropriate privilege log.

· Copies of the Policy and Policy Declarations Page.

· A copy of the Notification of Insured’s Rights as required by Fla. Stat. Sec. 627.7401 delivered by Defendant to the Insured (the “Notice”), including, but not limited to: the Notice, copies of any cover letter(s) or other correspondence accompanying the Notice and copies of any documents, papers or other forms or letters included with the Notice.

· Any and all documents reflecting bills submitted by Plaintiff and the dates that the bills were received by Defendant under the Claim, including Plaintiff’s bills reflecting Defendant’s date stamps and Defendant’s logs showing date of receipt of the bills.

· Any and all correspondence, documents, materials or other items regarding the medical reports and bills received from Plaintiff related to treatment provide to the Patient.

· To the extent that they exist, any and all Independent Medical Examination (“IME”) requests and IME Reports related to the Patient.

· To the extent that they exist, any and all Examinations Under Oath (“EUO”) requests, correspondence from the Defendant related to an EUO of the Patient, EUO transcripts related to the Patient or the Automobile Accident and any and all correspondence from any agencies hired by Defendant to schedule an EUO of the Patient, who were in attendance at the time of the scheduled EUO.

· To the extent that they exist, any and all reports or medical opinions or records review conducted in connection with Plaintiff’s medical services rendered to the Patient.

· Any and all statements taken by Defendant of any witnesses with regard to any fact relevant to any issues in this case, taken prior to the filing of the lawsuit in this matter.

· Copies of any and all medical records and billing records of other Providers of medical treatment/MRI/x-rays/emergency services rendered to the Patient in this Claim.

· Documents evidencing damage to the vehicle in which the Patient was an occupant, resulting from the Automobile Accident, including but not limited to estimates of property damage, repair bills, photographs and accident reports.

· Any and all reports or statements from any expert indicating that the treatment rendered by Plaintiff was not reasonable, not related or not necessary.

· Any and all information in Defendant’s possession which Defendant reviewed or upon which Defendant relied in calculating the “reasonable amount” as defined in Fla. Stat. Sec. 627.736(5)(a)(1) for Plaintiff’s medical services rendered to the Patient.

· Any State or Federal medical fee schedules that were applicable to automobile and other insurance coverages [other than the schedule of limited reimbursement contained in Fla. Stat. Sec. 627.736(5)(a)(2)] for the Relevant CPT Code Procedures, if relied upon in this case.

· Any and all proof upon which Defendant relies [other than the calculations contained in Fla. Stat. Sec. 627.736(5)(a)(2)] to dispute that the amounts charged by Plaintiff for the Relevant CPT Code Procedures were not reasonable charges.

· Other than the Policy, Medicare Fee Schedule and calculations contained in Fla. Stat. Sec. 627.736(5)(a)(2), any and all other documents reflecting any other relevant information considered by Defendant in determining, considering, assessing or evaluating the reasonableness or unreasonableness of Plaintiff’s Charges for performing the Relevant CPT Code Procedures.

· Any data and data compilations, analysis, spreadsheet(s), formula(s), average(s), survey(s), research, information and investigation(s) relied upon by Defendant in determining or calculating the “approved amounts” of the Charges/Submitted Amounts for the Relevant CPT Code Procedures.

· Copies of each and every document that supports, proves or tends to support any of the affirmative defenses Defendant asserts in the present litigation.

* * *