24 Fla. L. Weekly Supp. 68a
Online Reference: FLWSUPP 2401HAYEInsurance — Personal injury protection — Discovery — Depositions — Scope of inquiry at deposition of insurer’s corporate representative
EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, LLP as assignee of David Hayes, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Orange County. Case No. 2014-SC-10880-O. February 10, 2016. Jeanette Dejuras Bigney, Judge. Counsel: William S. England, Bradford Cederberg, P.A., Orlando, for Plaintiff. Benjamin W. Loving, Deland, for Defendant.ORDER
THIS MATTER having come before this Honorable Court on Defendant’s Motion for Protective Order and this Honorable Court having heard arguments of counsel and being otherwise fully advised in the premises, it is hereby,
ORDERED AND ADJUDGED that:
1. Defendant’s Motion for Protective Order is Granted in part and Denied in part. Defendant shall produce a corporate representative for deposition pursuant to Florida Rule of Civil Procedure 1.310(b)(6) and the Notice of Taking Deposition Duces Tecum attached hereto as Exhibit “A”.
2. Based upon Plaintiff’s withdrawal on the record, Plaintiff may not inquire as to the areas of inquiry in Paragraphs 6, 11, and 13 of the attached Notice of Taking Deposition.
3. With regards to Paragraphs 7, 9, and 10 of the attached Notice of Taking Deposition, Plaintiff’s inquiry is limited to a time frame of three months prior to date of service 2/7/2014, to three (3) months after date of service 2/7/2014.
4. With regards to Paragraph 16 of the attached Notice of Taking Deposition, Plaintiff may not inquire as to conclusions of law, legal interpretations, or legal opinions regarding Defendant’s Affirmative Defenses. Plaintiff may inquire as to facts only.
5. Due to time constraints, the Court could not address the Duces Tecum of the attached Notice.
__________________Exhibit ANOTICE OF TAKING TELEPHONICDEPOSITION DUCES TECUM
COMES NOW, the Plaintiff, EMERGENCY PHYSICIANS OF CENTRAL FLORIDA, LLP as assignee of David Hayes, and serves this Notice Of Taking Telephonic Deposition Duces Tecum, in the above-stated case, and requests that pursuant to Fla. R. Civ. P. 1.310(b)(6), the deposition of Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, and hereby requests that Defendant, STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, designate one or more officers, directors, or managing agents or other persons who consent to testify on its behalf and shall be knowledgeable regarding the following areas identified herein for the purpose of giving testimony pursuant to Fla. R. Civ. P. 1.310(b)(6):
1. Processing and non-payment of those amounts set forth in Plaintiff’s Complaint in this lawsuit, specifically Defendant’s denial of payment for the CPT Codes at I 94760 for the date(s) of service at issue.
2. Any reasonable proof in the possession of Defendant that it is not responsible for payment of CPT Code 94760 for the date(s) of service at issue in Plaintiff’s Complaint, including but not limited to, all documents, treatises, manuals, opinions, reports or any other information relied upon or that will be relied upon at any hearing and/or trial in this lawsuit.
3. Denial of CPT Code 94760 by Defendant when a medical provider’s bill includes CPT Code(s) 99281-99285.
4. Denial of CPT Code 94760 by Defendant, when a medical provider’s bill includes a critical care code.
5. Specific date range that Defendant has been denying payment for CPT Code 94760 when a medical provider’s bill includes CPT Code(s) 99281-99285.
6. The total amount that Defendant has saved (i.e., did not reimburse under an insured’s automobile policy under either PIP and/or Medical Payments benefits) during the specific date range that Defendant has been denying payment for CPT Code 94760 when a medical provider’s bill includes CPT Code(s) 99281-99285.
7. The relationship between Defendant and any employee and/or third party involved in any way in the processing and/or auditing of medical bills for Defendant’s policyholders, including the bill at issue in this matter.
8. Any instructions, procedures, information or documentation provided by Defendant to any third party auditing company with regards to denial of CPT Code 94760 when a medical provider’s bill includes CPT Code(s) 99281-99285.
9. Any information, documentation, and/or authority relied upon by Defendant that indicates in anyway it can deny reimbursement for CPT Code 94760 for the bill at issue.
10. 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, specifically CPT Code 94760, including original documents noting the date the documents were received.
11. Any and all information regarding statistical surveys of healthcare providers utilized by Defendant to reduce/deny the charges in this case, including health care providers surveyed regarding CPT Code 94760.
12. Any AMA publications or documentation upon which Defendant relied upon and/or is relying upon to deny payment of CPT 94760 for the bill at issue.
13. Any documents, reports, audits or other sources of information that indicate, for the three (3) year period preceding the date(s) of service at issue in this matter, the number of times that the Defendant (or any of its entities) received a bill for emergency services and care rendered in the State of Florida that included a charge for CPT Code 94760 for payment under an insured’s automobile insurance policy (either PIP and/or Medical Payments benefits), the name of the medical provider, the date of service, whether the bill included a charge for CPT Code 99281-99285, the amount of the charge for CPT Code 94760 and the amount that Defendant (or any of its entities) reimbursed the provider for CPT Code 94760 under the insured’s automobile insurance policy (either PIP and/or Medical Payments benefits).
14. Any documents, treatises, manuals, opinions, reports, statutes, correspondences or any other information or authority relied upon by Defendant at the time Defendant processed Plaintiff’s bill at issue and denied reimbursement for CPT Code 94760.
15. Any medical bill coding training manuals, coding policy and procedure manuals, coding guidelines, coding training class manuals, coding conference manuals, coding memorandums regarding CPT Code 94760.
16. Any and all Affirmative Defenses raised (or reserved) by Defendant in this matter, including any supporting basis.
Pursuant to Defendant’s designation, the deposition of said corporate representative(s) will be taken on February 25, 2016 at 10:30 a.m., at the offices of State Farm, 1500 State Farm Blvd., Charlottesville, VA 22903, and will continue from day-to-day, excluding weekends and holidays, until complete. The deposition will be taken before, First Choice Reporting Services, Inc., 121 S. Orange Avenue, Suite 800, Orlando, FL 32801, (407) 830-9044, (407) 767-8166, Notary Public, or some other officer authorized by law to take depositions. Said deposition is taken for all purposes allowed by the Florida Rules of Civil Procedure. Said deponent is to have with him/her the following items:
1. A complete copy of the claim file referenced in the Plaintiff’s Complaint for the assignor in this case, including, but not limited to: a certified copy of the subject declarations page; a certified copy of the subject policy of insurance including any and all applicable endorsements, amendments and/or riders; copies of any and all estimates of property damage for any vehicles involved in the subject loss; copies of any and all photographs of property damage of any vehicles involved in the subject loss; copies of any and all medical records received by the Defendant related to the subject claim; copies of any and all documents received by the Defendant related to the subject claim; copies of any and all medical bills received by the Defendant related to the subject claim; copies of any and all medical records received by the Defendant related to the subject claim; copies of any and all explanations of review/explanations of benefits (whether draft or final) issued by Defendant or any entity on Defendant’s behalf related to the subject claim for PIP benefits; copies of any and all forms completed by the assignor for the subject claim; copies of all computer/adjuster notes related to the subject claim up until the date of receipt of the pre-suit demand letter submitted on Plaintiff’s behalf for the treatment at issue in the subject claim; copies of any and all payments made, under any coverage, by the Defendant for the subject claim and any other documents kept and maintained in the ordinary course and scope of Defendant’s business as it relates to the subject claim.
2. Any and all correspondence, documents, materials or other items which are in your possession, including, but no limited to the medical reports and bills received from any and all medical providers who provided medical treatment to the assignor in this case.
3. Any and all correspondence, documents, materials or other items which are in your possession regarding the subject claim from the undersigned related to examination/treatment provided by any health care professional, including the Plaintiff, to the assignor in this case.
4. Any and all Independent Medical Examinations (hereinafter “IMEs”) or peer reviews (hereinafter “peer reviews”) and requests for same related to the assignor in this case.
5. Any and all Examination Under Oath (hereinafter “EUO”) requests and/or recorded statement requests and EUO transcripts and/or recorded statement 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.
6. 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.
7. 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.
8. 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.
9. 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”.
10. Any and all correspondence or documents 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.
11. A copy of any and all checks to Plaintiff, including explanation of benefits, related to treatment provided to the assignor in this case.
12. An up-to-date PIP Payout Sheet/PIP Log for the assignor in this case.
13. A copy of any and all correspondence sent by the Defendant to the assignor in this case (and/or his/her legal representative) and a copy of any and all correspondence sent by the assignor (and/or his/her legal representative) to the Defendant in this case.
14. A copy of any and documentation or evidence upon which Defendant relies to support any affirmative defenses timely/properly raised in this matter.
15. A copy of Defendant’s Verified Answers to Plaintiff’s Interrogatories, Defendant’s Responses to Plaintiff’s Request to Produce (including copies of all documents produced) and Defendant’s Responses to Plaintiff’s Request for Admissions in this matter.
16. A copy of any affidavits executed by any employee of the Defendant, or by any person at the Defendant’s request, or otherwise in the Defendant’s possession related in any way to the subject matter.
17. 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.
18. A copy of any and all contracts or agreements between Defendant and any third party billing company or vendor (i.e. Mitchell Medical, Mitchell International, Auto Injury Solutions, Corvel or any other) who in any way participated in the processing (i.e. receipt, review, auditing, recommending or explaining reimbursements, creating or generating explanations of review/benefits) of the medical bills submitted to Defendant for treatment rendered to the assignor in this case.
19. Any raw data relied upon by Defendant in determining the amount that it would reimburse Plaintiff for the bill(s) at issue in Plaintiff’s Complaint, including, but not limited to: any data utilized from any data base(s), geographical data, charts or compilations of data and any and all other information considered by Defendant when Defendant processed the subject bill(s) under the assignor’s PIP and/or Medical Payments coverage(s).
20. Any instructions given to any third party billing company or vendor (i.e. Mitchell Medical, Mitchell International, Auto Injury Solutions, Corvel or any other) by Defendant as to how medical bills submitted for payment under the assignor’s PIP and/or Medical Payments coverage(s) are to be reimbursed/paid (i.e. pursuant to a specific fee schedule).
21. Any treatises, publications, guides, manuals or any other document/information/authority relied upon by Defendant to support Defendant’s reimbursement decision for the bill(s) at issue.
