State Farm Mutual Automobile Insurance Co. v. Bowling
81 So. 3d 538
Fla. Dist. Ct. App.2012Background
- State Farm appeals a UM final judgment favoring Bowlings, reduced to UM policy limits.
- Jury awarded $944,154.50 for the Bowlings; judgment was reduced to $100,000 by the trial court.
- Issue centers on whether Debra Pacha, a medical billing/coding expert, could testify to reasonableness of medical expenses.
- Bowlings moved to exclude Pacha; trial court excluded her testimony as not qualified to opine on reasonableness.
- State Farm relied on Pacha to rebut Bowlings' damages; Bowlings relied on a one-page bill summary and Bowling’s testimony.
- Appellate panel held the trial court erred in excluding Pacha’s testimony and remanded for a new damages trial.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Admissibility of Pacha testimony on reasonableness | Bowling argues Pacha’s billing/coding expertise assists determining reasonableness. | State Farm contends Pacha is unqualified to opine on medical necessity/reasonableness. | Exclusion reversed; Pacha qualified to address coding reflectivity to bills. |
| Relevance and potential prejudice of billing-coding expert | Evidence tends to prove reasonableness/necessity of charges and supports defense against fraud claims. | Evidence would misdirect focus to third-party billing acts and be prejudicial collateral issue. | Admission appropriate; relevant to reasonableness, not unduly prejudicial as collateral issue. |
| Remand for damages trial | New damages trial is warranted to properly determine medical expenses. | Existing record suffices for damages; no new trial needed. | Final judgment reversed and remanded for new trial on damages. |
Key Cases Cited
- USAA Cas. Ins. Co. v. Shelton, 932 So. 2d 605 (Fla. 2d DCA 2006) (damages must be proven reasonable and related to accident in UM claim)
- Albertson's, Inc. v. Brady, 475 So.2d 986 (Fla. 2d DCA 1985) (burden to prove reasonableness/necessity of medical expenses)
- Shaw v. Puleo, 159 So.2d 641 (Fla.1964) (reasonableness/necessity standard in medical expenses)
- Johnson v. State, 393 So.2d 1069 (Fla.1980) (expert testimony must relate to disputed issue beyond ordinary understanding)
- McWatters v. State, 36 So.3d 613 (Fla. 2010) (trial court broad discretion in evidentiary rulings on experts)
- Pascual v. Dozier, 771 So.2d 552 (Fla. 3d DCA 2000) (unavailability or exclusion of witness context; collateral issue concerns)
- Flores v. Allstate Ins. Co., 833 So.2d 172 (Fla. 2d DCA 2002) (PIP evidence relevance and potential prejudice in UM action)
- Dungan v. Ford, 632 So.2d 159 (Fla. 1st DCA 1994) (lay testimony may establish necessity without expert opinion)