22 Fla. L. Weekly Supp. 1059a
Online Reference: FLWSUPP 2209JMIKInsurance — Personal injury protection — Med Pay — Discovery — Reasonableness of charges — Once insurer elected to pay PIP and Med Pay benefits under permissive statutory fee schedule, reasonableness of charges became irrelevant — Motion to compel responses to discovery regarding reasonableness of charges is denied
STAND-UP MRI OF TALLAHASSEE, P.A., As assignee of Jill Mikkelson, Plaintiff, vs. STATE FARM MUTUAL AUTOMOBILE, INSURANCE COMPANY, Defendant. County Court, 2nd Judicial Circuit in and for Leon County. Case No. 2013 SC 2186. August 21, 2014. Robert R. Wheeler, Judge. Counsel: Brett D. Sahm, Bradford Cederberg, P.A., Orlando, for Plaintiff. Andrew L. Chiera, Luks Santaniello, Boca Raton, for Defendant.
ORDER DENYING DEFENDANT’S MOTION TO COMPEL BETTER RESPONSESTO DEFENDANT’S DISCOVERY
This matter having come before the Court upon Defendant’s Motion to Compel Better responses to Defendant’s Discovery, and the Court having heard the argument of counsel and being adequately advised of the premises thereof, it is hereby Ordered and Adjudged:
1. Plaintiff has sued Defendant alleging that Defendant failed to make full payment of PIP/Med Pay benefits due under the applicable statutes.
2. To support its defense, Defendant propounded Interrogatories and a Request to Produce to Plaintiff seeking information and documents regarding the reasonableness of the charge.
3. Plaintiff objects to Defendant’s requests on the ground the information and documents requested are irrelevant. Plaintiff claims that Defendant elected to pay benefits under the permissive payment methodology set forth in Florida Statute 627.736(5)(a)(2) which limits payment to 80% of 200% of the allowable amount under Medicare Part B, rather than under the reasonable charge methodology set forth in Florida Statute 627.736(5)(a)(1). Consequently, Plaintiff claims that the reasonableness of the charge is not at issue because Defendant chose the alternative permissive payment method to compute benefits. This court agrees.
4. Benefits paid pursuant to the permissive payment method under (5)(a)(2) is the statutory minimum amount insurers may reimburse. See Pan Am Diagnostic Services, Inc., D/B/A, Pan Am Diagnostic of Orlando v. Metropolitan Casualty Insurance Company, 19 Fla. L. Weekly Supp. 874a (Fla. 17th Cir., Broward Cty 2012); Tomoka Diagnostics a/a/o Kellye McCall v. State Farm Mutual Automobile Insurance Co., 19 Fla. L. Weekly Supp. 60a (Fla. 7th Cir., Volusia Cty 2011). Insurers have the option of paying a “reasonable” amount under (5)(a)(1), or opting for payment permissive payment method in (5)(a)(2). Consequently, any payment less than that made in (5)(a)(2) is prohibited.
5. If an insurer chooses to pay benefits under the permissive payment method set forth in (5)(a)(2), the statutory minimum, then any issue of whether this payment is “reasonable” is not relevant. In the case at hand, Defendant chose not to employ the “reasonableness” method to calculate the benefits paid, and thus, it cannot now attempt to create an issue of fact as to the reasonableness of Plaintiff’s charges. See Pan Am Diagnostic Services, Inc., supra. Defendant is bound by its decision to utilize the methodology in (5)(a)(2), and it cannot now attempt to create an issue as to reasonableness. See Tomoka Diagnostics, supra.
The Court specifically rejects State Farm’s argument that it can belatedly contest the “reasonableness” of the charge submitted by the Plaintiff as an affirmative defense to the claim. The amount charged by Plaintiff is irrelevant. Once State Farm elected to take advantage of the statutory fee schedule found at 627.736(5)(a)(2), there remained no factual dispute regarding the “reasonableness” of the charge and the only issue was the mathematical determination of the correct reimbursement amount under the fee schedule.
New Smyrna Imaging, LLC a/a/o Bernard Goshay v. State Farm Mutual Automobile Insurance Co., 19 Fla. L. Weekly Supp. 126b (Fla. 7th Cir. Volusia Cty 2011).
Defendant’s Motion to Compel is DENIED.
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