22 Fla. L. Weekly Supp. 123c

Online Reference: FLWSUPP 2201CONTInsurance — Personal injury protection — Discovery — Depositions — Order establishing scope and deposition of insurer’s corporate representative and materials representative is required to bring to deposition

FLORIDA HOSPITAL MEDICAL CENTER, as assignee of Jose Conty, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2013-SC-5300-O. January 17, 2014. Adam McGinnis, 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 December 20, 2013, on Defendant, State Farm Mutual Automobile Insurance Company’s (“State Farm”) Motion for Protective Order and the Court having heard argument of counsel, and being otherwise advised in the premises, it is hereby,

ORDERED AND ADJUDGED that:

1. State Farm’s Motion for Protective Order is Granted in part and Denied in part. 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.

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 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.

5. 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.

6. 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.

7. Any and all instances where State Farm provided its insured or Plaintiff notice of its intent to limit reimbursement to the Medicare Fee Schedule amounts, prior to or on the date of service at issue.

8. Inquiry regarding any of the documents listed in the duces tecum included herein.

The Defendant’s Corporate Representative is to 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 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 Independent Medical Examination (hereinafter “IME”) requests and IME reports related to the assignor in this case.

4. 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.

5. Any and all reports or correspondence between or among Defendant or anyone in any organization with respect to any medical opinions or records review conducted in any manner in connection with the treatment provided by the Plaintiff to the assignor in this case, including original documents noting the date the documents were received.

6. 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.

7. Any and all correspondence related to or from anyone, including any insurance agencies, any employers, any agencies who were hired to select doctors, schedule “IMEs” or paper/peer review reports related to the assignor in this case.

8. Any and all correspondence related to or from anyone, including any insurance agencies, any employers, any agencies who were hired to schedule an “EUO” related to the assignor in this case who were in attendance at the time of the set “EUO”.

9. 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.

10. A copy of any and all checks to Plaintiff, including explanation of benefits, related to treatment provided to the assignor in this case.

11. An up-to-date PIP Payout Sheet/PIP Log for the assignor in this case.

12. 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.

13. Statistical formulas for the calculation of “reasonable and customary” reductions by the 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.

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