22 Fla. L. Weekly Supp. 374a
Online Reference: FLWSUPP 2203MOREInsurance — Personal injury protection — Discovery — Depositions — Documents — Reimbursement levels in community
M & M MEDICAL CENTER, INC., A/A/O ADOLFO MORENO, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 11th Judicial Circuit in and for Miami-Dade County. Case No. 13-16444-SP-23(1). September 19, 2014. Myriam Lehr, Judge. Counsel: Robert B. Goldman, Florida Advocates, Dania Beach, for Plaintiff. Joel M. McNabney, Beighley, Myrick & Udell, P.A., Miami, for Defendant
ORDER ON PLAINTIFF’S AMENDED MOTION TOCOMPEL DISCOVERY (TO COMPEL DEFENDANT TOPRODUCE A CORPORATE REPRESENTATIVE TO TESTIFYREGARDING REIMBURSEMENT LEVELS IN THECOMMUNITY), AND DEFENDANT’S MOTION FORPROTECTIVE ORDER AS TO THE DEPOSITION OFDEFENDANT’S CORPORATE REPRESENTATIVE
THIS CAUSE having come before the Court on September 19, 2014 upon the motions of the Plaintiff, M & M MEDICAL CENTER, INC. a/a/o Adolfo Moreno (“M & M”) and the Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY (“STATE FARM”). M & M has filed an Amended Motion to Compel Discovery — to Compel STATE FARM to produce a corporate representative to testify regarding reimbursement levels in the community and to produce reports using Decision Point Software evidencing the charges of other medical providers in the community and reimbursement levels in the community. STATE FARM has filed a Motion for Protective Order regarding Plaintiff’s request to conduct the deposition of Defendant’s corporate representative, and the Court having considered the motions, having heard argument of counsel and being otherwise fully advised, it is hereupon
ORDERED as follows: Plaintiff shall be permitted to inquire as to Defendant’s determination to pay Plaintiff’s claim at a reduced rate, and the methodology, basis, facts and calculations to determine the reasonableness and payment of charges at issue in this claim.
1. M&M shall be entitled to conduct the deposition of STATE FARM’s designated corporate representative and conduct inquiry regarding reimbursement levels in the community where the services were performed, as reflected by
a. the amounts which chiropractors and chiropractic facilities in Miami-Dade County, Florida have charged STATE FARM for performing CPT Codes 97010, 97032, 97034, 97035, 97039, 97110, 97112, 97140, 98941, 99203, 99211, 99212, 99213, G0283 and L0627, the same CPT codes that are at issue in this case (the “Relevant CPT Code Procedures”), for procedures performed during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012;
b. the amounts which STATE FARM has allowed as reasonable, approved or authorized charges for chiropractors and chiropractic facilities in Miami-Dade County, Florida who have billed STATE FARM for the Relevant CPT Code Procedures, for procedures performed during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012; and
c. the amounts which STATE FARM has paid chiropractors and chiropractic facilities in Miami-Dade County, Florida who have billed STATE FARM for the Relevant CPT Code Procedures, for procedures performed during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012.
2. STATE FARM shall bring the entire PIP claim file to the deposition. 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.
3. STATE FARM need not provide the underwriting file or the application for insurance, unless STATE FARM contests coverage.
4. STATE FARM shall produce at the deposition a report using Decision Point Software or similar software, reflecting the following information:
a. identification of chiropractors and chiropractic facilities located within the Community of Miami-Dade County, who have performed the Relevant CPT Code Procedures during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012, and who have billed STATE FARM for those procedures;
b. the amounts charged by chiropractors and chiropractic facilities within the Community of Miami-Dade County, Florida, for performing the Relevant CPT Code Procedures during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012;
c. 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 of Miami-Dade County, Florida, performed during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012; and
d. the amounts paid by STATE FARM to chiropractors and chiropractic facilities located within the Community of Miami-Dade County, Florida for the Relevant CPT Code Procedures, performed during the period of time from December 1, 2007 through December 31, 2007 and from August 1, 2012 through December 31, 2012.
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