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It is not every day that the Florida Supreme Court rules on an issue that involves Florida’s Personal Injury Protection insurance laws, which are also known as Florida Motor Vehicle No-Fault Laws (No-Fault Laws).  These are the laws that govern the payment of medical bills and lost wages for individuals involved in car, truck, motorcycle, and pedestrian traffic accidents.  This week the Supreme Court issued an opinion regarding what discovery is permissible by insurance companies looking to evade payments even before they even sued for non-compliance.

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The case arose from a conflict between Florida’s PIP statute and opinions issued by Florida’s First and Fourth District Courts of Appeal over what charges were appropriately paid out of a PIP and what discovery would be available by an insurance company even before it was sued for non-compliance under the policy.  The facts of the case involve medical treatment rendered by Shands Jacksonville Medical Center (Shands) to twenty-nine people who carried State Farm PIP Insurance and were injured in motor vehicle accidents.

After paying Shands, State Farm requested documentation relating to the “reasonableness of the charges,” pursuant to section 627.736(6)(b) of Florida’s PIP statutes. This section requires healthcare providers to provided PIP insurance companies like State Farm, upon request, specific documents and information relating to the treatment of injured persons and the associated costs. In other words, insurance companies use discovery like this as a basis for refusing to make payments even before a lawsuit is filed.

In response, Shands provided State Farm with the medical records documenting the treatments and charges for the services rendered, its most recent Medicare Cost Report, as well as its cost information, and comparative cost information obtained from Florida’s Agency for Health Care Administration (AHCA). This information demonstrated what other similar hospitals would have charged for the same procedures.

However, Shands refused to furnish copies of its contracts with third parties, which contain negotiated discount rates between Shands and other insurers and payers. Shands contended that this information was not required by the statute. State Farm, in an attempt to elude responsibility for paying the medical expenses, filed a petition asking the trial court to compel the production of the withheld information, and to order Shands to make a corporate representative available for deposition.

The trial court agreed with State Farm, finding that the language of the PIP Statute permits the discovery of evidence of the reasonableness of charges. Furthermore, the trial court adopted the reasoning of the Fourth District Court of Appeal’s ruling that the phrase “discovery of facts” is not limited to just the production of documents, but also includes the right to take the “deposition testimony and other means of obtaining information authorized by the Florida Rules of Civil Procedure” of Shands’ corporate representatives.  

The trial court then ordered Shands to produce the requested discovery and granted State Farm’s request to depose a corporate representative about documents and information.

Shands appealed, and the First District Court of Appeal reversed the trial court’s entire order, concluding that it exceeded the scope of discovery permissible under the PIP statute, and ordered that discovery be limited to just the production of the documents and not depositions.((Specifically, the Florida Rules of Civil Procedure provide that “Parties may obtain discovery by one or more of the following methods: depositions upon oral examination or written questions; written interrogatories; production of documents or things or permission to enter upon land or other property for inspection and other purposes; physical and mental examinations; and requests for admission.” Id. at 985 (quoting Fla. R. Civ. P. 1.280(a)). ))

Herein lies the conflict at issue for the Supreme Court: The Fourth District required that a healthcare provider’s corporate president submit to a deposition. The First District Court reasoned that when the Legislature used the legal term of art “discovery of facts,” it borrowed the term “discovery” from the Florida Rules of Civil Procedure, which allows for depositions.  

In other words, the court interpreted the word “discovery” to authorize the discovery of “facts,” and not merely the production of documents. Consequently, the district court concluded that the healthcare provider’s refusal to supply any of the requested information established a “good cause” for the trial court’s order to compel the corporate president to submit to a deposition in order to verify the amount due under the PIP policy.

Since this case concerns a certified conflict between the First District Court of Appeal and the Fourth District Court of Appeal regarding the extent of permissible discovery pursuant to Florida’s PIP Statute, the Supreme Court applied a standard of review known as “de novo.”  This means that they look at a case from the perspective of a trial court and must look at the legislature’s intent when interpreting a statute such as the PIP statute. Legislative intent simply means, “what did Florida’s legislature intend?” when they drafted what appears to be an ambiguous statute.  

The interpretation of the “intent is derived primarily from the language of the statute.” When wording of the law is clear, courts are without power to diverge from the intent of the Legislature.   Here, however, the plain language of the PIP statute was considered to be unclear–as evidenced by the fact that two trial courts and two appellate courts rendered opposite interpretations as to what the “discovery of facts” language in the statute means and how it should be applied. The First District held that the phrase “discovery of facts” is limited to the production of the documents, which is in direct contrast to and conflicts with the Fourth District’s construction that “discovery of facts” includes all methods of discovery available under the Florida Rules of Civil Procedure–including depositions. Therefore, the phrase “discovery of facts” is susceptible to more than one interpretation; it was therefore necessary for the Supreme Court to utilize principles of statutory construction to figure out exactly what the legislative intent was.((See Rollins v. Pizzarelli, 761 So. 2d 294, 297-98 (Fla. 2000) (quoting Forsythe v. Longboat Key Beach Erosion Control Dist., 604 So. 2d 452, 455 (Fla. 1992).))  

This ambiguity suggests that reasonable people can find different meanings in the same words. and therefore the Supreme Court was required to review the PIP statute as a whole, including “the evil to be corrected, the language, the title, and history of its enactment, and the state of law already in existence on the statute.”((Fla. Dep’t of Envtl. Prot. v. ContractPoint Fla. Parks, LLC, 986 So. 2d 1260, 1266 (Fla. 2008) (quoting Bautista v. State, 863 So. 2d 1180, 1185 (Fla. 2003).))

It is well recognized that the intended purpose of Florida’s PIP law is to “provide swift and virtually automatic payment”((Nunez v. Geico Gen. Ins. Co., 117 So. 3d 388, 393 (Fla. 2013) (quoting Ivey v. Allstate Ins. Co., 774 So. 2d 679, 683-84 (Fla. 2000)). )) and yet allow insurance companies like State Farm to simply

verify the legitimacy of a claim by seeking discovery of facts regarding an injured before it pays PIP benefits. It makes sense that insurance companies can and should obtain discovery to which they are entitled in the event of a dispute.

The Supreme Court agreed with the First District Court of Appeal that the “discovery of facts” before a lawsuit is filed is limited to the specific facts of treatment and that the related billing of the injured person 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 . . . ”  However, once a lawsuit is filed over the reasonableness of those charges, medical providers are not required to submit any of their representatives to a deposition.((STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Petitioner, vs. SHANDS JACKSONVILLE MEDICAL CENTER, INC., Respondent. Supreme Court of Florida. Case No. SC15-1257. February 16, 2017. ))

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Florida’s Personal Injury Protection law can be confusing and requires an experienced personal injury lawyer who is familiar with the complex nuances of what medical bills and lost wages are paid after a traffic accident, and how. If you have been involved in a car accident, truck accident, bicycle accident, or pedestrian accident in Florida, contact our Miami personal injury law firm today to discuss your potential case

We offer anyone who has a potential claim a free initial consultation by telephone, at 305-441-0440, or toll free at 1-866-597-4529, email at [email protected], SKYPE, or FACETIME. We have over 30 years of combined legal experience representing the injured in accidents across the state of Florida. Call us today–we are ready to help.