178 So. 3d 511
Fla. Dist. Ct. App.2015Background
- Delray Medical treated two State Farm insureds and submitted PIP bills; State Farm disputed reasonableness and sought documentation under Fla. Stat. § 627.736(6)(b).
- State Farm served extensive discovery (including cost reports, payments accepted from other payers, insurer contracts, and community reimbursement data) and filed a petition seeking court-ordered discovery under § 627.736(6)(c) after partial production by Delray.
- The trial court denied the petition for lack of good cause and found the requests overbroad; it also declined to take judicial notice of an AHCA cost-report summary State Farm submitted.
- On appeal, the core question was whether § 627.736(6)(b) permits discovery into provider-wide or third-party payment information (e.g., amounts accepted from Medicare/private insurers) to assess charge reasonableness.
- The Fourth District held discovery under subsection (6)(b) is limited to facts and documents concerning the injured person’s treatment and related billing; broader market or contract reimbursement data is not authorized by that subsection.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Scope of discovery under § 627.736(6)(b) | State Farm: insurer entitled to documents showing amounts others paid (Medicare/private contracts) to assess reasonableness of charges | Delray: (6)(b) is limited to records about the injured person's treatment and billing, not third‑party payment data | Discovery limited to documents about the injured person’s treatment and related costs; third‑party payment/market data not allowed under (6)(b) |
| Use of § 627.736(5) to compel broader discovery | State Farm: subsection (5) identifies factors (usual/customary, accepted payments) relevant to reasonableness and thus permits discovery of that evidence | Delray: subsection (5) governs standards for reasonableness in litigation, not the scope of (6)(b) discovery; (5) is inapplicable to (6)(b) production demands | Court: (5) does not expand discovery rights under (6)(b); (5) lists evidentiary factors for disputes over charges but is not a discovery grant |
| Good‑cause requirement under § 627.736(6)(c) | State Farm: good cause shown by allegation that Delray charged well above Medicare rates and by partial production/refusal of requested items | Delray: State Farm failed to show good cause for the broad, third‑party financial discovery sought | Court: State Farm did not meet the good‑cause standard for the expansive discovery requested; trial court did not err in denying discovery |
| Judicial notice of AHCA cost report | State Farm: AHCA report showed Delray’s reimbursement rates were far below billed charges and supported discovery | Delray: disagreed as to relevance and scope; trial court declined notice | Court: trial court permissibly declined judicial notice and stated the report would not change the ruling; no reversible error found |
Key Cases Cited
- Kaminester v. State Farm Mut. Auto. Ins. Co., 775 So. 2d 981 (Fla. 4th DCA 2000) (interpreting § 627.736(6)(b) and finding lease for MRI equipment discoverable as a treatment cost item)
- State Farm Mut. Auto. Ins. Co. v. Goldstein, 798 So. 2d 807 (Fla. 4th DCA 2001) (discovery under § 627.736(6) pertains to services allegedly provided to the insured)
- City of Fort Pierce v. Shannon R. Ginn Constr. Co., 705 So. 2d 934 (Fla. 4th DCA 1997) (statutory titles can illuminate legislative intent)
- Fla. Dep’t of Envtl. Prot. v. ContractPoint Fla. Parks, LLC, 986 So. 2d 1260 (Fla. 2008) (courts should consider statute as a whole, including title and history, to discern legislative intent)