22 Fla. L. Weekly Supp. 854b
Online Reference: FLWSUPP 2207GILMInsurance — Personal injury protection — Discovery — Interrogatories — Insurer’s claims processing procedures and method of determining reasonableness of charges and reimbursement levels in community — Scope of discovery
DR. ROBERT S. SCHWARTZ, P.A., a Florida Corporation (a/a/o Gilmore, Michael), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 12-23796 COCE 50. January 20, 2015. Peter B. Skolnik, Judge. Counsel: Robert Goldman, Florida Advocates, Dania Beach, for Plaintiff.
ORDER ON PLAINTIFF’S MOTIONTO OVERRULE DEFENDANT’S OBJECTIONSTO FIRST INTERROGATORIES
THIS CAUSE having come before the Court on January 8, 2015 upon Plaintiff’s Motion to Overrule Defendant’s Objections to First Interrogatories and Compel Verified Answers to First Interrogatories, and the Court having heard argument of counsel and being otherwise fully advised, it is hereupon
ORDERED that Plaintiff’s motion is GRANTED in part and DENIED in part, and Defendant’s Objections to First Interrogatories are SUSTAINED in part and OVERRULED in part, as follows:
Interrogatory No. 5
Please state the how, when and whom on Defendant’s behalf, was provided notice of this claim.
Defendant’s Objection to Interrogatory No. 5
Overly broad, vague and ambiguous, not reasonably calculated to lead to the discovery of admissible evidence.
The Court’s Ruling on Interrogatory No. 5
The Court SUSTAINS Defendant’s objection.
Interrogatory No. 8
Please describe the exact method by which you calculated the amount payable for the medical bill(s), submitted to you by the Plaintiff, which is/are at issue in this case.
Defendant’s Objection to Interrogatory No. 8
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence.
The Court’s Ruling on Interrogatory No. 8
The Court OVERRULES Defendant’s objection.
Interrogatory No. 9
For the medical bill(s) received by you from the Plaintiff, which is/are at issue in this case, please state: the date of the bill(s), the date(s) of service for which the bill(s) was/were incurred, the date you first received the bill(s), the dollar amount for the bill(s) received, the date you first acted to determine whether or not the bill(s) reflected a reasonable, necessary, and related charge, and the date you first decided what constituted a reasonable payment amount.
Defendant’s Objection to Interrogatory No. 9
In determining a payment amount, objection: work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence.
The Court’s Ruling on Interrogatory No. 9
The Court OVERRULES Defendant’s objection.
Interrogatory No. 10
Please state the complete name, business address, residence address, telephone number, date of birth, and job title of each person working for you or on your behalf, during the period of time running from one year before the date of service at issue in this case to the present date, who are the most knowledgeable about your standards, procedures, and practices with regard to handling the questions of your adjusters pertaining to how to calculate what constitutes a “reasonable” charge and/or payment pursuant to Florida Statutes § 627.736 in the geographical area of where the treatment took place in this case.
Defendant’s Objection to Interrogatory No. 10
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 10
The Court SUSTAINS in part and OVERRULES in part Defendant’s objection. Defendant is required to answer interrogatory no. 10 by providing the requested information as it relates to the handling of this claim and the specific CPT Codes at issue in this claim.
Interrogatory No. 11
Please state the complete name, residence address, business address, telephone number, date of birth, and job title of each individual working for you or on your behalf, during the period of time running from one year before the date of service at issue in this case to the present date, who are or were involved in the decision to deny and/or reduce payments of PIP claims and litigate over those claims versus making payment of those claims in the amount of eighty percent (80%) of the billed charges.
Defendant’s Objection to Interrogatory No. 11
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 11
The Court SUSTAINS in part and OVERRULES in part Defendant’s objection. Defendant is required to answer interrogatory no. 11 by providing the requested information as it relates to the handling of this claim and the specific CPT Codes at issue in this claim.
Interrogatory No. 13
Please describe, in detail, what method you employed to determine what the reimbursement levels in the community are under Florida Statutes § 627.736 for the medical bill(s) submitted by the Plaintiff, what geographical area was considered in respect to this claim, and specify the name of the providers in the geographical area considered, amount of their charges submitted as PIP claims for the same type of diagnostic procedure as in this case, and whether or not you relied on this information in determining what amount of charge and/or payment would be reasonable under pursuant to Florida Statutes § 627.736 for the medical bill(s) at issue in this case.
Defendant’s Objection to Interrogatory No. 13
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 13
The Court OVERRULES Defendant’s objection.
Interrogatory No. 14
Please identify by title and description, all manuals, memos, writings, seminars, audio tapes, video tapes, and any other materials used by your company or anyone on your behalf to explain to your own adjusters the policies and procedures which they are to follow to determine the correct amount of a payment under Florida Statutes § 627.736(5)(a)(1).
Defendant’s Objection to Interrogatory No. 14
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 14
The Court OVERRULES Defendant’s objection.
Interrogatory No. 16
Please provide a complete list of all medical review companies who have handled the review of any of your medical bills for cases governed under Florida Statutes § 627.736 for any of your policies of automobile insurance issued by you in Florida from January 1, 2007 to the present and provide the name, address, and telephone numbers of each, and provide a description and exact location of any contracts, writings, memos, reports, records, notes or any other documentation pertaining to said medical review companies.
Defendant’s Objection to Interrogatory No. 16
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 16
The Court SUSTAINS in part and OVERRULES in part Defendant’s objection. Defendant is required to answer interrogatory no. 16 by providing the requested information as it relates to the handling of this claim and the specific CPT Codes at issue in this claim.
Interrogatory No. 17
Please list the name, address, and official position of each and every person in your employ or in the employment of anyone on your behalf, who has had any involvement whatsoever in the review of the medical bill(s) submitted by the Plaintiff, for the determination that payment of the bill in the amount of 80% of the billed amount was not “reasonable” pursuant to Florida Statutes § 627.736, and state in what capacity each person was involved, the dates when they were involved, and the exact nature of their involvement.
Defendant’s Objection to Interrogatory No. 17
Work product and/or attorney client privileged.
The Court’s Ruling on Interrogatory No. 17
The Court OVERRULES Defendant’s objection.
Interrogatory No. 18
Please describe, in detail, what method you employ to determine what the reimbursement levels in the community are under Florida Statutes § 627.736 for other independent diagnostic testing facilities for the same or similar diagnostic test as billed for by the Plaintiff, what amount you consider to be reasonable under Florida Statutes § 627.736 for other independent diagnostic testing facilities in the same geographical area for the same or similar diagnostic test, and specify the name of the other independent diagnostic testing facilities in the geographical area of the Plaintiff for which you have paid a similar medical bill under a PIP policy in the past three years, amount of their charges for the same type of diagnostic procedure as in this case, and whether or not you relied on this information in determining what amount of charge and/or payment would be reasonable under Florida Statutes § 627.736 for the medical bill(s) at issue in this case.
Defendant’s Objection to Interrogatory No. 18
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 18
The Court SUSTAINS in part and OVERRULES in part Defendant’s objection. Defendant is required to answer interrogatory no. 18 by providing the requested information as it relates to the handling of this claim and the specific CPT Codes at issue in this claim.
Interrogatory No. 19
Please describe, in detail, what method you employ to determine what the reimbursement levels in the community are under Florida Statutes § 627.736 for hospitals and ambulatory surgical centers for the same or similar diagnostic test as billed for by the Plaintiff, what amount you consider to be reasonable under Florida Statutes § 627.736 for hospitals and ambulatory surgical centers in the same geographical area for the same or similar diagnostic test, and specify the name of any hospitals and ambulatory surgical centers in the geographical area of the Plaintiff for which you have paid a similar bill under a PIP policy in the past three years, amount of their charges for the same type of diagnostic procedure as in this case, and whether or not you relied on this information in determining what amount of charge and/or payment would be reasonable under Florida Statutes § 627.736 for the medical bill(s) at issue in this case.
Defendant’s Objection to Interrogatory No. 19
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 19
The Court SUSTAINS in part and OVERRULES in part Defendant’s objection. Defendant is required to answer interrogatory no. 19 by providing the requested information as it relates to the handling of this claim and the specific CPT Codes at issue in this claim.
Interrogatory No. 20
Have you ever been a named defendant in a lawsuit involving an alleged violation of Florida Statutes § 627.736(11) or any predecessor statute, or an alleged violation of Florida Statutes § 624.155 or any predecessor statute? Was a judgment entered? If judgment was entered, please state the jurisdiction in which the judgment was entered, the case number, the date filed, and amount of the judgment. If judgment was not entered, please describe the outcome of the lawsuit, including the terms and the amount of settlement, if any.
Defendant’s Objection to Interrogatory No. 20
Overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 20
The Court SUSTAINS Defendant’s objection.
Interrogatory No. 21
Please describe with detail any and all manuals, studies, statistics, compiled data, or other similar sources upon which you relied on to determine what a usual and customary charge is for the medical bill at issue in this case under Florida Statutes § 627.736.
Defendant’s Objection to Interrogatory No. 21
Work product and/or attorney client privileged, trade secret, proprietary, overly broad, not reasonably calculated to lead to the discovery of admissible evidence, harassing.
The Court’s Ruling on Interrogatory No. 21
The Court OVERRULES Defendant’s objection.
Interrogatory No. 22
Please list the names, residence addresses, business addresses, and telephone numbers of all persons who, on your behalf or on behalf of any of your agents, employees, or representatives, including your attorneys, to have in any way participated in the selection of the medical review company that has reviewed any of the medical bill(s) involved herein (both specifically for this case and generally for your company), specify the nature of the participation for each and every person, and give the time period during which they participated.
Defendant’s Objection to Interrogatory No. 22
Work product, proprietary, trade secret, overly broad, not reasonably calculated to lead to the discovery of admissible evidence.
The Court’s Ruling on Interrogatory No. 22
The Court OVERRULES Defendant’s objection.
Defendant shall provide verified answers to the First Interrogatories within 30 days from the entry of this Order.
* * *
