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Court Rules Insurer is Entitled to New Trial Based on Exclusion of Expert Testimony on Medical Billing and Coding

July 8, 2011

State Farm Mutual Automobile Insurance Company v. Bowling, — So. 3d —, 36 Fla. L. Weekly D1487 (Fla. 2d DCA July 8, 2011).


The insurance carrier retained a medical billing and coding expert to testify about the reasonableness of the charges for the medical treatment of the policyholder. After comparing the bills to the medical treatment records, the expert found charges that were not supported by any medical codes. The trial court excluded the expert after ruling that her testimony would not assist the jury and that she was not qualified to opine as to the reasonableness of the medical bills. The case proceeded to trial, where two of the policyholder’s medical providers admitted that certain bills included items that should not have been billed. After the jury returned a verdict for the policyholder, the carrier appealed.


The plaintiff must prove that his or her medical bills are both reasonable and necessary. The Second District Court of Appeal concluded that medical billing and coding testimony regarded a “technical matter of which the jury did not have basic knowledge.” The court explained that the expert’s testimony was relevant to whether the bills were reasonable and necessary because it would have assisted the jury in determining whether the medical bills accurately reflected the treatment the policyholder was documented to have received. Further, based on the expert’s training and experience, the Second District determined that the expert was qualified to opine on (1) whether the medical bills were properly coded and (2) whether they accurately reflected treatment documented in the medical records. Thus, the court reversed and remanded for a new trial.

Appellate Counsel: Anthony J. Russo and Ezequiel Lugo of Butler Pappas Weihmuller Katz Craig, LLP, Tampa; and Mark S. Ramey of Ramey & Kampf, P.A., Tampa, for State Farm Mutual Automobile Insurance Company.