26 Fla. L. Weekly Supp. 897b
Online Reference: FLWSUPP 2611GUILInsurance — Personal injury protection — Discovery — Depositions — Motion to compel deposition of corporate representative of claims management company who made determination that more documentation was needed for insured’s PIP claim is denied where discovery insured seeks is not relevant to issue of whether insurer’s explanation of reimbursement informing insured that additional documentation was needed to make reimbursement decision constituted request for documentation under section 627.736(6)(b) — Even if court found that EOR contained 6(b) request for documentation, requested deposition would not be relevant as testimony of employee of company is not binding on insurer
ISO DIAGNOSTIC TESTING INC., a/a/o Marie Guillaume, Plaintiff(s) v. USAA GENERAL INDEMNITY COMPANY, Defendant(s). County Court, 17th Judicial Circuit in and for Broward County. Case No. COCE15015390, Division 49. October, 18, 2018. Nina W. Di Pietro, Judge. Counsel: Kevin R. Jackson, Law Offices of Kevin Jackson, P.A., Fort Lauderdale, for Plaintiff. Oliver Wragg, Fort Lauderdale, for Defendant.
ORDER DENYING PLAINTIFF’S MOTIONTO COMPEL DEPOSITION AND GRANTINGDEFENDANT’S MOTION FOR PROTECTIVE ORDER
THIS CAUSE having come on to be heard on August 27, 2018, regarding Plaintiff’s Motion to Compel Deposition of Auto Injury Solutions’ Corporate Representative pursuant to 1.310(b)(6) and Defendant’s Objection, Response in Opposition and Motion for Protective Order as to Plaintiff’s Motion to Compel, the Court having reviewed said Motion, Response, and the court file, and being otherwise advised in the Premises, the Court finds as follows:
The patient in this case, Marie Guillaume, sustained injuries in an automobile accident on August 11, 2014. At that time, Ms. Guillaume was covered under a policy of insurance issued by Defendant, USAA General Indemnity Company (hereinafter “Defendant”). On October 21, 2014, ISO Diagnostic Testing, Inc. (hereinafter “Plaintiff”), as an assignee of Ms. Guillaume, submitted a bill to Defendant for medical services rendered to Ms. Guillaume on September 16, 2014. On or about November 6, 2014, Defendant issued an Explanation of Reimbursement (hereinafter “EOR”) informing Plaintiff that further documentation was needed in order to make a reimbursement decision. Defendant ultimately paid $512.18 of the $1,090.00 billed by Plaintiff.
On July 1, 2015, Plaintiff filed a Complaint against Defendant alleging that Defendant still owes Plaintiff outstanding PIP benefits as well as postage and penalties for the aforementioned paid PIP benefits. On October 9, 2015, Defendant filed its Answer and Affirmative Defenses. Of the ten affirmative defenses asserted, five surround Defendant’s claim that Plaintiff failed to respond to Defendant’s request for documentation contained within its November 6, 2014 EOR. At this juncture, the parties are in dispute as to whether the November 6, 2014 EOR contained a statutory document request pursuant to section 627.736(6)(b), Florida Statutes (hereinafter “6(b) request”). Section 627.736(6)(b), Florida Statutes, states as follows:
Every physician, hospital, clinic, or other medical institution providing, before or after bodily injury upon which a claim for personal injury protection insurance benefits is based, any products, services, or accommodations in relation to that or any other injury, or in relation to a condition claimed to be connected with that or any other injury, shall, if requested by the insurer against whom the claim has been made, furnish a written report of the history, condition, treatment, dates, and costs of such treatment of the injured person and why the items identified by the insurer were reasonable in amount and medically necessary, together with a sworn statement that the treatment or services rendered were reasonable and necessary with respect to the bodily injury sustained and identifying which portion of the expenses for such treatment or services was incurred as a result of such bodily injury, and produce, and allow the inspection and copying of, his or her or its records regarding such history, condition, treatment, dates, and costs of treatment if this does not limit the introduction of evidence at trial. . . If an insurer makes a written request for documentation or information under this paragraph within 30 days after having received notice of the amount of a covered loss under paragraph (4)(a), the amount or the partial amount that is the subject of the insurer’s inquiry is overdue if the insurer does not pay in accordance with paragraph (4)(b) or within 10 days after the insurer’s receipt of the requested documentation or information, whichever occurs later. . . .
Fla. Stat. §627.736(6)(b) (2014). The above quoted statute provides a pre-litigation procedure for a PIP insurer to obtain limited information from a medical provider seeking PIP benefits. State Farm Mutual Automobile Insurance Company v. Shands Jacksonville Medical Center, Inc., 210 So. 3d 1224 (Fla. 2017) [42 Fla. L. Weekly S176a]. Following the receipt of a bill from the medical provider, an insurer may request a written report containing information about the treatment provided to the insured and the charges for that treatment prior to reimbursement becoming due. State Farm Mutual Automobile Insurance Company v. Delray Medical Center, Inc., 178 So. 3d 511 (Fla. 4th DCA 2015) [40 Fla. L. Weekly D2467a]. Once the medical provider’s requested documentation is received, the insurance company has 10 additional days before payment is considered overdue.
On May 25, 2016 and January 4, 2017, the parties came to the Court for discovery hearings. Plaintiff proffered that it had in its possession documentation showing different ways in which Defendant has previously made 6(b) requests in other cases. The Court found that the form and manner in which Defendant generally makes 6(b) requests, as well as Defendant’s explanation regarding the way in which the proffered requests were made compared to the form and manner of the November 6, 2014 EOR request, was relevant to the issue of whether the request in this case constituted a 6(b) request. Following those hearings, the undersigned entered orders requiring Defendant’s litigation adjuster and/or corporate representative to answer questions in deposition regarding Defendant’s general practices regarding 6(b) requests.
Before the Court presently is Plaintiff’s Motion to Compel Deposition of Auto Injury Solutions’ Corporate Representative and Defendant’s Objection, Response in Opposition and Motion for Protective Order. Plaintiff moves to compel, and Defendant opposes and moves to prevent, the deposition of a corporate representative for Auto Injury Solutions (hereinafter “AIS”), the company used by Defendant to generate the November 6, 2014 EOR. Specifically, Plaintiff argues that this deposition is necessary as Defendant’s litigation adjuster, Anabel Weis, testified in two separate depositions that an AIS employee made the determination that more documentation was needed for Plaintiff’s claim. At the hearing on August 27, 2018, this Court made the initial ruling granting Defendant’s Motion for Protective Order as it related to a deposition of a corporate representative for AIS, but deferred ruling as to whether the Court would permit Plaintiff to take the deposition of the employee at AIS who specifically handled Plaintiff’s claim.
It is clear from the evidence contained within the court file that there is at least one employee at AIS who possesses first-hand knowledge regarding the processing of Plaintiff’s bill, the determination of a potential deficiency in Plaintiff’s initial bill submission, and what additional documentation was believed to have been needed in order to make a final reimbursement decision. It is also clear that Defendant’s litigation adjuster does not have firsthand knowledge regarding any of the above. Despite this however, the Court finds that the discovery Plaintiff seeks from AIS is not relevant to the issue before the Court, specifically the factual and/or legal determination of whether the November 6, 2014 EOR contained a 6(b) request. Further, even if the Court was to find that the November 6, 2014 EOR contained a 6(b) request, discovery from the AIS employee would still not be relevant as the AIS employee’s testimony is not binding on Defendant.
ORDERED AND ADJUDGED that Plaintiff’s Motion to Compel Deposition of Auto Injury Solutions’ Corporate Representative pursuant to 1.310(b)(6) is hereby Denied and Defendant’s Motion for Protective Order is hereby Granted for the reasons stated above.
