Florida Supreme Court Resolves District Courts of Appeal Conflict Regarding Personal Injury Protection Discovery

Personal Injury Protection (PIP) benefits are designed to help people injured in a car accident receive prompt payments. Section 627.736 of the Florida Statutes addresses which types of medical services are paid using PIP, and it grants insurance companies the right to request information related to payment to help ensure costs are reasonable and not inflated.  A recent Florida Supreme Court case (No. SC15-1257) addresses the extent of permissible discovery under section 627.736(6)(c), Florida Statutes (2015). This case arose from the First District Court of Appeal and is in conflict with another decision from the Fourth District, Kaminester v. State Farm Mutual Automobile Insurance Co., 775 So. 2d 981(Fla. 4th DCA 2000), over which types of methods can be used to obtain discovery.The Fourth District allowed for extensive discovery, while the First District declined to permit insurers the ability to request information that goes beyond documentation of the care that was provided, the costs of the care, and a comparison to costs in the area.

The medical services provider at the center of this litigation previously provided care to 29 insureds who were injured in separate car accidents. The victims’ auto insurer, after paying the medical provider, requested documentation related to the reasonableness of the charges, as outlined by section 627.736(6)(b). Section 627.736(6)(b) requires a health care provider to furnish, upon request, documents and information related to the costs and treatment provided to the injured insured. The medical provider gave the insurer medical records, documents related to treatment and services rendered, the most recent Medicare Cost Report, cost information, and comparative cost information from the Agency for Health Care Administration to show what other hospitals charge for the same procedures. The hospital refused to provide copies of third-party contracts that would have shown the negotiated, discounted rates between the medical services center and other insurers and payers.

The insurer filed a petition to the trial court to compel discovery of this information. The trial court agreed with the auto insurance company, finding that the statute’s language extended to the third-party contracts. The court used the reasoning in Kaminester, holding that the discovery of facts was not limited to document production but included deposition testimony and other ways of obtaining information as allowed by the state’s Rules of Civil Procedure. On appeal, the First District reversed the ruling of the trial court, parting with the decision of the Fourth District and determining that the insurance company was limited to the documents listed in subsection (6)(b).

The Supreme Court ultimately sided with the First District’s interpretation of Florida’s Personal Injury Protection (PIP) statutes, overturning the Fourth District’s decision in Kaminester. The court looked at the phrase “discovery of facts” within section 627.736, ruling that the process outlined in the subsections is meant to be a limited pre-litigation procedure. The Supreme Court disagreed with the Fourth District, determining that the rules of civil procedure are not triggered until litigation begins over the reasonableness of the charges.

Filing a claim after a car accident can easily become complicated. A experienced Florida auto accident attorney at Donaldson & Weston can assist you with your insurance claim and other avenues of legal relief. Call today at 772-266-5555 or 561-299-3999 for a free, confidential consultation.