October 29, 2021, Jury Trial, Medical Necessity, Relatedness, and Reasonableness of Thoracic MRI.

Style: LCM Imaging, Inc. d/b/a AFO Imaging, inc. d/b/a Advanced Diagnostic Group, as assignee of Carmen Polanco v. State Farm Mutual Automobile Company

Venue: County Court, Orange County, Florida

On May 20, 2014, State Farm’s insured, Carmen Polanco, was a restrained driver in a motor vehicle that was struck by another vehicle’s tire after coming to a full stop on Interstate 4.  After a gap of treatment, the insured sought medical treatment with a non-party provider, that then recommended Ms. Polanco obtain a thoracic MRI on June 17, 2014.  Ms. Polanco underwent the thoracic MRI on July 7, 2014, with the Plaintiff medical provider, LCM Imaging, Inc.  

Upon receipt of LCM Imaging, Inc.’s billing, State Farm sought a review of the records to another medical doctor, Doctor Mark Hofmann, to perform a peer review to determine the medical necessity, relatedness, and reasonableness of the thoracic MRI.  On September 12, 2014, Ms. Polanco underwent an independent medical examination that was performed by Doctor Mark Hofmann.  After reviewing the records and his in-person examination, Doctor Mark Hofmann determined the Thoracic MRI was not medically necessary, related, or reasonable.

Following the filing of the suit by Plaintiff, Defendant proceeded with this peer review defense through trial.   At trial, the Plaintiff presented Ms. Polanco, Dr. Findley, and Defendant’s Expert, Dr. Hofmann.  Due to the distance of the witnesses, the parties had previously taken the video depositions of the witnesses in lieu of trial.

• Experts testifying for plaintiff included:
  • Ulysses Findley, MD.
• Experts testifying for the defendant included:
  • Mark Hofmann, MD.

The jury deliberated for an hour to render a verdict for the defendant, State Farm, and Plaintiff was awarded nothing in damages.

Counsel for the defendant, David Kampf, Esq., and L. Allen Gaffney, Esq.