Supreme Court limits information insurers may demand under PIP policies - SaintPetersBlog

Supreme Court limits information insurers may demand under PIP policies

The Florida Supreme Court has taken a narrow view of the amount of evidence hospitals and other health care providers are obliged to turn over to insurance companies concerning the reasonableness of personal injury protection claims.

In a unanimous ruling, the court sided with the 1st District Court of Appeal over the 4th District Court of Appeal, which had issued conflicting interpretations of Florida’s PIP statute.

“We conclude that discovery is limited to the production of 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, as well as the production, inspection and copying of records regarding such history, condition, treatment, dates, and costs of treatment,” Chief Justice Jorge Labarga wrote.

“Furthermore, we agree that (the statute) provides limited pre-litigation discovery into specified information about the treatment and charges for treatment provided to an injured party, and that the discovery tools found in the rules of civil procedure … are not triggered until litigation over the reasonableness of those charges has ensued.”

Justice C. Alan Lawson, who only recently joined the court, did not participate.

The dispute in State Farm Mutual Automobile Insurance Co. v. Shands Jacksonville Medical Center Inc. centered on the insurer’s attempt to collect information about the treatment afforded 29 insured following auto accidents.

Florida’s PIP statute allows insurers “discovery of fact” — meaning access to provider records to determine whether the treatment was reasonable.

Shands delivered medical records, documents detailing treatments and charges, its Medicare cost report, and data reflecting what other hospitals charged for the same procedures.

Shands refused to turn over copies of third-party documents covering discounts it had negotiated with other carriers. State Farm sued for those records. A trial judge ruled that the company was entitled to them.

The 1st DCA and the 4th DCA, in a similar dispute, disagreed about the amount of information Shands was obliged to turn over. The first court took a narrow view, holding that State Farm was entitled only to records spelled out in subsection 6 (a) — essentially, the information Shands had delivered.

The latter court took a more expansive view, ruling that the Florida Rules of Civil Procedure’s broader discovery rules applied.

The Supreme Court agreed with the 1st DCA that the Legislature intended the statute to afford a “limited pre-litigation procedure for a PIP insurer to obtain specified information about the treatment provided to its insured and the charges for that treatment.”

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Michael Moline is a former assistant managing editor of The National Law Journal and managing editor of the San Francisco Daily Journal. Previously, he reported on politics and the courts in Tallahassee for United Press International. He is a graduate of Florida State University, where he served as editor of the Florida Flambeau. His family’s roots in Jackson County date back many generations.
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