22 Fla. L. Weekly Supp. 931a
Online Reference: FLWSUPP 2208STINInsurance — Personal injury protection — Discovery — Depositions — Scope of inquiry regarding reasonableness of charges and reimbursement levels in community and documents to be produced at deposition of insurer’s corporate representative
HERNANDO HMA, LLC, D/B/A BROOKSVILLE REGIONAL HOSPITAL, (ASSIGNEE OF STINNETT, BILLY), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 5th Judicial Circuit in and for Hernando County. Case No. SC-13-188. February 27, 2015. Motion for Reconsideration April 16, 2015. Donald McCathran, Jr., Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff. Birdy V. Vanasupa and Christopher John Blain, Vernis & Bowling of the Gulf Coast, P.A., for Defendant.ORDER APPROVING TOPICS OF INQUIRY ATNEW DEPOSTION OF STATE FARM ANDDOCUMENTS TO BE PRODUCED BY STATE FARMIN CONJUNCTION WITH THAT DEPOSITION[Original Opinion at 22 Fla. L. Weekly Supp. 480b]
THIS CAUSE having come before the Court upon the motion of the Plaintiff, HERNANDO HMA, LLC d/b/a BROOKSVILLE REGIONAL HOSPITAL (a/a/o Stinnett, Billy) (“BROOKSVILLE”) for clarification of this Court’s ruling at the hearing on October 20, 2014, and or for entry of an Order approving the topics of inquiry and documents to be produced in conjunction with the new deposition of the corporate representative or person with the most knowledge on behalf of STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY (“STATE FARM”), and the Court having considered the proposed Notice of Hearing attached as Exhibit “B” to the motion and being otherwise fully advised, it is hereupon
ORDERED that BROOKSVILLE’s motion is GRANTED, as follows:
1. BROOKSVILLE shall be entitled to conduct the deposition of STATE FARM’s designated corporate representative or person with the most knowledge and conduct inquiry regarding the following topics:
(a) The amounts that other hospitals in Hernando County, Florida, have charged STATE FARM for performing CPT Code Procedures J1885, J2360, 72050, 90772 and 9928325 (the “Relevant CPT Code Procedures”), during the months of October and November 2008.
(b) The amounts that STATE FARM has allowed as reasonable, approved or authorized charges for hospitals in Hernando County, Florida that have billed STATE FARM for the Relevant CPT Code Procedures, for procedures performed during the months of October and November of 2008.
(c) The amounts that STATE FARM has paid hospitals in Hernando County, Florida that have billed STATE FARM for the Relevant CPT Code Procedures, for procedures performed during the months of October and November of 2008.
(d) The report that this Court required to be prepared and produced by STATE FARM ten (10) days in advance of the deposition of the designated corporate representative of STATE FARM or person with the most knowledge.
(e) STATE FARM’s position that the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008 were not reasonable, the basis for that position and any evidence to support that position.
(f) The methodology, basis, facts and calculations used by STATE FARM to determine that BROOKSVILLE’s charges for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008 were not reasonable.
(g) Any investigation undertaken by STATE FARM to determine, consider or assess the reasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
(h) Any research undertaken by STATE FARM to determine, consider or assess the reasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
(i) Any comparative studies undertaken by STATE FARM to determine, consider or assess the reasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
(j) Any analysis undertaken by STATE FARM to determine, consider or assess the reasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
(k) Other than 75 percent of BROOKSVILLE’s usual and customary charges, any other information considered by STATE FARM in determining or assessing the reasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
2. STATE FARM’s designated corporate representative or person with the most knowledge shall have the following documents at the deposition:
(a) A report using Decision Point software or similar software, identifying the hospitals in Hernando County, Florida, that have performed the Relevant CPT Code Procedures, during the months of October and November 2008, and who have billed STATE FARM for those procedures. If State Farm uses such software.
(b) A report using Decision Point software or similar software, reflecting the amounts that other hospitals in Hernando County, Florida, have charged for performing the Relevant CPT Code Procedures, during the months of October and November 2008. If State Farm uses such software.
(c) A report using Decision Point software or similar software, reflecting the amounts that STATE FARM has allowed as reasonable, approved or authorized charges for hospitals in Hernando County, Florida that have billed STATE FARM for the Relevant CPT Code Procedures, for procedures performed during the months of October and November of 2008. If State Farm uses such software.
(d) A report using Decision Point software or similar software, reflecting the amounts that STATE FARM has paid hospitals in Hernando County, Florida that have billed STATE FARM for the Relevant CPT Code Procedures, for procedures performed during the months of October and November of 2008. If State Farm uses such software.
(e) Documentation evidencing any investigation undertaken by STATE FARM to determine, consider or assess the reasonableness or unreasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures, for the benefit of Billy Stinnett on October 25, 2008.
(f) Documentation evidencing any research undertaken by STATE FARM to determine, consider or assess the reasonableness or unreasonableness of the amounts charged by BROOKSVILLE for performing the Relevant CPT Code Procedures, for the benefit of Billy Stinnett on October 25, 2008.
(g) Documentation evidencing any comparative studies undertaken by STATE FARM to determine, consider or assess the reasonableness or unreasonableness of the amounts charged by BROOKSVILLE for performing for the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
(h) Documentation evidencing any analysis undertaken by STATE FARM to determine, consider or assess the reasonableness or unreasonableness of the amounts charged by BROOKSVILLE for performing for the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
(i) Documents reflecting any other information considered by STATE FARM in determining, considering or assessing the reasonableness or unreasonableness of the amounts charged by BROOKSVILLE for performing for the Relevant CPT Code Procedures for the benefit of Billy Stinnett on October 25, 2008.
__________________AMENDED ORDER DENYINGDEFENDANT’S MOTION FOR RECONSIDERATIONAS TO PLAINTIFF’S MOTION FOR CLARIFICATION
THIS CAUSE having come before the Court upon Defendant’s Motion for Reconsideration as to Plaintiff’s Motion for Clarification and the Court having reviewed the motion and being duly advised, it is hereby;
ORDERED and ADJUDGED that Defendant’s motion is DENIED. The denial is based upon two factors. The first factor is the Court has entered a Stay of Litigation and believes the trial court is divested of jurisdiction while an appeal is pending.
Secondly, even if the trial court had jurisdiction, the motion would also be denied. The Court will briefly set forth its reasoning for allowing the questioned discovery as it may or may not assist in the appellate court in review of this case. As is often the case in discovery disputes in “PIP” cases, Plaintiff’s attorney provided the undersigned with several County Court orders from various Florida jurisdictions that allowed the same discovery while Defendant’s attorney provided the undersigned with several County Court orders from various Florida jurisdictions that did not allow the same discovery. Neither Plaintiff nor Defendant was able to provide authority by a Circuit Court appellate panel, a District Court of Appeal, or the Florida Supreme Court that would guide the undersigned in his ruling regarding this specific discovery issue.
The trial court has wide latitude in permitting discovery. Given the undersigned’s background as a prosecutor, unless the discovery is clearly not permissible by rule, statute, or case law the undersigned takes an approach that tends to allow for a broad, wider reaching discovery to ensure the parties have all of the facts available to them so that they may advise their clients to making an informed decision as to either settle a case or proceed to a jury trial.
The undersigned reviews the discovery requests on a case by case basis and allows the attorneys to argue the reasons for or against the discovery. In this case the undersigned does not agree with the Defendant’s attorney’s argument that allowing the discovery in question is an improper shifting of the burden of proof upon Defendant. Plaintiff continues to bear the burden of proof in the above styled cause. Asking an adjuster or corporate representative of Defendant questions in a deposition regarding factors considered in determining whether the charges were reasonable or unreasonable does not shift Plaintiff’s burden of proof at a trial before a jury. The discovery sought relates to the usual and customary charges and payments (made by State Farm); reimbursement levels in the community (payments made by State Farm); and, any other evidence relevant to the reasonableness of the charges (Plaintiff s attorney has to be able to ask questions of the witness to determine whether they have any other evidence relevant to the reasonableness of charges). Furthermore, Defendant have failed to show any prejudice Defendant would suffer by a representative answering the questions and/or providing the information as numerous other courts have required them to do so.
The Court welcomes appellate review of this issue as it will provide the County Courts and attorneys within the Fifth Judicial Circuit binding authority; and other County Courts and attorneys outside the Fifth Judicial Circuit with persuasive authority, to follow as these discovery issues addressed routinely.
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