25 Fla. L. Weekly Supp. 124a
Online Reference: FLWSUPP 2501NOLAInsurance — Personal injury protection — Coverage — Medical expenses — Reasonableness of charges — Collateral estoppel — Motion to apply collateral estoppel to prevent insurer from litigating reasonableness of charge for particular CPT code is granted where same parties actively litigated identical issue in 15 prior cases, issue was critical part of each prior case, and insurer was given full and fair opportunity to litigate issue in prior cases
HEALTH DIAGNOSTICS OF MIAMI, LLC, d/b/a STAND-UP MRI OF MIAMI, a/a/o Melissa Nolasco, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. CONO 13-008355(71). March 9, 2017. Louis H. Schiff, Judge. Counsel: Andrew J. Weinstein, Weinstein Law Firm, Coral Springs, for Plaintiff. Viraj A. Mehta, Cole, Scott & Kissane, P.A., West Palm Beach, for Defendant.
ORDER GRANTING PLAINTIFF’S MOTION FORTHE APPLICATION OF COLLATERAL ESTOPPEL
THIS CAUSE having come on to be heard on February 28, 2017, on Plaintiff’s motion for the application of collateral estoppel and the Court having heard argument of counsel, having reviewed the Court file, having reviewed all applicable case law, and being otherwise advised in the Premises, it is hereupon,
ORDERED AND ADJUDGED that said Motion be, and the same is hereby GRANTED for the reasons set forth below.
The doctrine of collateral estoppel is a judicial creation that originates from the common law. See United States v. Mendoza, 464 U.S. 154, 158 (1984); Mobil Oil Corp. v. Shevin, 354 So. 2d 372, 375 (Fla. 1977); Prall v. Prall, 50 So. 867, 870 (Fla. 1909). Its historical development was founded based on the need to reduce the cost of multiple lawsuits, conserve judicial resources, and encourage reliance on adjudication, by preventing inconsistent decisions. Mendoza, 464 U.S. at 158; Prall, 50 So. at 870. The doctrine accomplishes these objectives by precluding a party from re-litigating in a subsequent cause of action the same issues that were litigated and decided in a prior cause of action between the same parties. See e.g., Provident Life and Accident Ins. Co. v. Genovese, 138 So. 3d 474 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D442b]; Zimmerman v. Fla. Office of Ins. Regulation, 944 So. 2d 1163 (Fla. 4th DCA 2006) [31 Fla. L. Weekly D3126a]; Stogniew v. McQueen, 656 So. 2d 917, 919 (Fla. 1995) [20 Fla. L. Weekly S208a]; Gordon v. Gordon, 59 So. 2d 40, 44 (Fla. 1952); Criner v. State, 138 So. 3d 557, 558 (Fla. 5th DCA 2014) [39 Fla. L. Weekly D930a].
The requirements for the doctrine of collateral estoppel to apply are well settled in Florida and are relatively straightforward. For the doctrine to apply, the following five elements must be met: (1) an identical issue must be presented in a prior proceeding; (2) the issue must have been a critical and necessary part of the prior determination; (3) there must have been a full and fair opportunity to litigate the issue; (4) the parties in the two proceedings must be identical; and (5) the issues must have been actually litigated. See e.g., Atria v. Hodor, 790 So. 2d 1229, 1230 (Fla. 4th DCA 2001) [26 Fla. L. Weekly D1929a]; Lucky Nation, LLC v. Al-Maghazchi, 186 So. 3d 12 (Fla. 4th DCA 2016) [41 Fla. L. Weekly D139a]; Provident Life and Accident Ins. Co. v. Genovese, 138 So. 3d 474 (Fla. 4th DCA 2014) [39 Fla. L. Weekly D442b]; Zimmerman v. Fla. Office of Ins. Regulation, 944 So. 2d 1163 (Fla. 4th DCA 2006) [31 Fla. L. Weekly D3126a].
In support of its position, Plaintiff relies upon 15 separate final judgments entered in its favor in similar lawsuits, all of which were attached to its motion for this Court’s consideration and review. All of the 15 underlying cases involved the Plaintiff, Health Diagnostics of Miami, LLC, and the Defendant, State Farm; all of the 15 underlying cases involved the same geographical area and similar timeframe; all of the 15 underlying cases involved the issue of whether Plaintiff’s charge of $1,600 for CPT code 72141 was within the range of what is reasonable; and all of the 15 underlying cases were actively litigated by the same parties for 3-4 years before disposition was entered.
Addressing the elements for the doctrine to apply, first, there is no question that the issue in this case of whether Plaintiff’s charge of $1,600 for CPT code 72141 is within the range of what is reasonable is identical to the issue presented in the underlying 15 cases. As such, the first element is satisfied. Second, there is no question that this issue was a critical and necessary part of the prior proceedings since the determination of that issue was essential to the ultimate decision. In a lawsuit for unpaid personal injury protection benefits, the issue of whether “the charge for the service is reasonable” is a critical and necessary part of that lawsuit, since it is an element of Plaintiff’s cause of action. As such, the second element is satisfied. Third, there is no question that State Farm was given a full and fair opportunity to litigate the issue in each of the underlying cases as those cases were litigated for 3-4 years and were resolved after a lengthy hearing where both parties were given adequate notice and allowed to present evidence. As such, the third element is satisfied. Fourth, there can be no dispute that the parties involved in the case at bar and the parties involved in the 15 underlying cases are identical. As such, the fourth element is satisfied. Fifth, there is no question that the issue was actually litigated in the underlying 15 cases since the final judgments that were entered in favor of the Plaintiff resulted from a court making a determination in each of those cases that Plaintiff’s $1,600 charge for CPT code 72141 was within the range of what is reasonable. As such, the fifth element is satisfied.
This case falls squarely within the purpose of the doctrine of collateral estoppel and meets all of the criteria for its application. The parties to this litigation “have had their day in court” and any repetitious litigation at this point of identical issues would serve no purpose other than to tie up the court system and cause delay.
