22 Fla. L. Weekly Supp. 857a
Online Reference: FLWSUPP 2207MENAInsurance — Personal injury protection — Discovery — Interrogatories — Use of medical billing software — Scope of discovery
RONALD J. TRAPANA, M.D., P.A., a Florida Corporation (a/a/o Mena, Laura), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 12-12979 COCE 52. January 23, 2015. Giuseppina Miranda, Judge. Counsel: Robert Goldman, Florida Advocates, Dania Beach, for Plaintiff.
ORDER GRANTING PLAINTIFF’SMOTION TO COMPEL BETTER RESPONSESTO SUPPLEMENTAL INTERROGATORIESAND OVERRULING DEFENDANT’S OBJECTIONS
THIS CAUSE having come before the Court on January 12, 2015 upon Plaintiff’s Motion to Compel Better Responses to Supplemental Interrogatories, and the Court having considered the Supplemental Interrogatories and Defendant’s objections thereto, having heard argument of counsel and being otherwise fully advised, it is hereupon
ORDERED that Plaintiff’s motion is GRANTED, Defendant’s objections are OVERRULED, and Defendant shall serve better answers to the Supplemental Interrogatories, for the reasons set forth below:
1. On or about September 19, 2014, Plaintiff RONALD J. TRAPANA, M.D., P.A. propounded its Supplemental Interrogatories to Defendant (Re: Reasonableness) (the “Supplemental Interrogatories”) in this PIP case, consisting of 9 interrogatories.
2. The Supplemental Interrogatories included the following Definitions:
The “Medical Services” means the medical services that were provided by the Plaintiff for the benefit of the assignor in this case, the charges for which the Defendant has claimed are unreasonable, and as a result of which the Plaintiff has brought this lawsuit.
The “Medical Bill” or the “Medical Bills” means the bill(s), statement(s) or invoice(s) that were submitted by the Plaintiff as a result of having provided the Medical Services.
The “Claim” means the claim for Personal Injury Protection benefits that was asserted by Plaintiff as a result of providing the Medical Services and submitting the Medical Bills, and as a result of which Plaintiff has filed this lawsuit against You.
The “Relevant Period” means the period of time from 45 days prior until 45 days after the date(s) on which the Plaintiff performed the Medical Services.
“Community” means the Florida County in which the Plaintiff performed the Medical Services, provided that during the Relevant Period, there were at least 12 other medical providers practicing medicine in the same specialty area(s) of practice as the Plaintiff, located within the county in which Plaintiff performed the Medical Services.
“Decision Point” refers to “the medical claims billing software provided by Mitchell International, Inc. (“Mitchell”) and used by You in the processing, adjusting and/or handling of PIP Claims.”
3. The interrogatories to which Defendant objected are as follows:
Interrogatory No. 2
Identify the manner in which you utilized Decision Point Software in processing the Claim, from the time of receipt of the Medical Bills up until payment.
Interrogatory No. 3
According to Mitchell, Decision Point enables the creation of automatic workflow connections based upon business rules defined by the insurance company that are specific to how the insurance company wants its claims handled. In utilizing Decision Point for the purpose of processing Florida PIP claims, identify the business rules You have defined that are specific to how you want Florida PIP claims handled.
Interrogatory No. 4
In utilizing Decision Point for the purpose of processing Florida PIP claims, have you utilized the Medicare Fee Schedule in defining business rules regarding the handling of such PIP claims?
Interrogatory No. 5
Have You utilized Decision Point to adjust Florida PIP claims based upon the Medicare Fee Schedule?
Interrogatory No. 6
With regard to Florida PIP claims, have You instructed Your claims adjusters to rely upon information provided by Mitchell or Decision Point in determining whether or not a charge for a medical service is reasonable?
Interrogatory No. 7
With regard to the Claim, did you rely upon information provided by Mitchell or Decision Point in determining that the Plaintiff’s charge for the Medical Services was not reasonable?
Interrogatory No. 8
Identify the name, address, email address and telephone number of Mitchell’s representative assigned to work with You for the purpose of answering questions that may arise concerning Your use of Decision Point in the processing of Florida PIP claims
Interrogatory No. 9
Identify the name, address, email address and telephone number of Mitchell’s representative assigned to answer questions that may arise concerning the use of Decision Point to generate a report showing what other medical providers in the Community have charged for the identical CPT codes at issue in this Claim, during the Relevant Period.
4. Defendant raised the identical objections to interrogatory nos. 2- 9, objecting on the grounds of “trade secret, proprietary, work-product, attorney-client privileged, and not reasonably calculated to lead to admissible evidence, as the Defendant is not relying on any pre-suit payment or methodology to defend the issue of the reasonableness of Plaintiff’s charges.” In addition, Defendant objected to interrogatory no. 3 as vague and ambiguous.
5. This Court finds that the information requested in the Supplemental Interrogatories is completely relevant to this PIP case, and reasonably calculated to lead to the discovery of admissible evidence on the issues concerning the reasonableness of the Plaintiff’s charge.
6. This Court further finds that the information requested in the Supplemental Interrogatories is neither protected proprietary information, trade secret or attorney-client privileged.
7. Accordingly, all objections are OVERRULED, and the Defendant is directed to provide verified answers to the Supplemental Interrogatories within thirty five (35) days from the date of the hearing.
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