[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
FILED
U.S. COURT OF APPEALS
ELEVENTH CIRCUIT
No. 11-10162 MARCH 27, 2012
JOHN LEY
CLERK
D. C. Docket No. 1:10-cv-20116-UU
DWFII CORPORATION,
a Florida corporation, a/a/o Christopher Obioha
and a/a/o Alex Rodriquez, on behalf of itself and
all others similarly situated,
d.b.a. Falls Chiropractic Health Center,
Plaintiff-Appellant,
versus
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY,
a foreign corporation,
STATE FARM FIRE AND CASUALTY COMPANY,
a foreign corporation,
Defendants-Appellees.
Appeal from the United States District Court
for the Southern District of Florida
(March 27, 2012)
Before DUBINA, Chief Judge, ANDERSON and KLEINFELD,* Circuit Judges.
PER CURIAM:
Appellant DWFII Corporation (“DWFII”) filed a class action against
Appellees State Farm Mutual Automobile Insurance Company and State Farm Fire
and Casualty Company (collectively “State Farm”) challenging State Farm’s use
of National Correct Coding Initiative (“NCCI”) edits to determine the proper
reimbursement for Personal Injury Protection (“PIP”) claims under Florida’s no
fault insurance statute, FLA. STAT. § 627.7346 et seq. DWFII defined the class for
which it sought to certify as including:
All Florida health care providers who (1) submitted a claim to a
Defendant for payment under an applicable Florida PIP and/or
medical payments policy; (2) had their claim reduced or denied; and
(3) a Defendant generated an EOR with a reason code of 318, 319,
322, and/or 323 stating that the basis for the non-payment of the
particular claim was the application of an NCCI edit.
[R. 42 at 6.] The district court denied DWFII’s motion for class certification and
dismissed the action for a lack of subject matter jurisdiction. DWFII appeals the
*
Honorable Andrew J. Kleinfeld, United States Circuit Judge for the Ninth Circuit, sitting
by designation.
2
district court’s determination. After thoughtfully considering the parties’ briefs,
and with the benefit of oral argument, we find no reversible error. Therefore, we
affirm.
I.
A district court’s decision on class certification under Federal Rule of Civil
Procedure 23 is reviewed for abuse of discretion. Heffner v. Blue Cross & Blue
Shield of Ala., Inc., 443 F.3d 1330, 1337 (11th Cir. 2006). The district court’s
decision will not be disturbed if its reasoning stays within the parameters set forth
in Rule 23 for class certification. Id.
In order to obtain class certification, DWFII must satisfy all requirements
set forth in Federal Rule of Civil Procedure 23(a) and at least one standard
described in Rule 23(b). Turner v. Beneficial Corp., 242 F.3d 1023, 1025 (11th
Cir. 2001). We conclude from the record that the district court properly found that
DWFII is unable to satisfy the Rule 23(a) typicality prerequisite that “the claims
or defenses of the representative parties [be] typical of the claims or defenses of
the class.” FED. R. CIV. P. 23(a)(3). DWFII is also unable to show that “final
injunctive relief or corresponding declaratory relief is appropriate respecting the
class a whole” or that “questions of law or fact common to class members
3
predominate over any questions affecting only individual members” under Rule
23(b). FED. R. CIV. P. 23(b)(2)–(3).
II.
First, DWFII is unable to satisfy the typicality prerequisite of Rule 23(a).
Even if the class is able to show that NCCI edits are impermissible under FLA.
STAT. § 627.736 et seq., each individual medical service provider in the class must
still demonstrate that it is entitled to reimbursement for the disputed charges—i.e.,
the bill was properly completed pursuant to FLA. STAT. § 627.736(5)(b)(1)(d), the
benefits of the insurance plan were not exhausted at the time of the procedure, the
recipient of the medical services had valid insurance coverage with State Farm,
and the medical provider actually performed the services for which it billed.
Furthermore, State Farm is entitled to present any unbundling or set off defenses
that would allow it to properly reduce the amount of reimbursement due. FLA.
STAT. § 627.736(5)(b)(1)(e). Because each claim would require the establishment
of different facts and would be subject to different defenses, we conclude that the
district court did not abuse its discretion in finding that this prerequisite was not
met and class certification was therefore improper.
Moreover, DWFII cannot satisfy one of the standards set forth in Rule
23(b). A declaratory or injunctive relief class pursuant to Rule 23(b)(2) is
4
appropriate only if “the predominant relief sought is injunctive or declaratory.”
Murray v. Auslander, 244 F.3d 807, 812 (11th Cir. 2001) (internal quotation
marks and citation omitted). DWFII seeks both monetary and injunctive or
declaratory relief, and “[m]onetary relief predominates in (b)(2) class actions
unless it is incidental to the requested injunctive or declaratory relief.” Id.
(emphasis in original) (internal quotation marks and citation omitted). Monetary
damages are incidental when “class members automatically would be entitled [to
them] once liability to the class . . . as a whole is established[,]” and awarding
them “should not entail complex individualized determinations.” Id. (internal
quotation marks and citation omitted). Incidental damages are “more in the nature
of a group remedy.” Id. (internal quotation marks and citation omitted). In the
present case, if the class was able to prevail on its claim, each medical service
provider in the class would have to establish individual facts regarding the type of
services performed, the amounts billed, and the amount of reimbursement received
from State Farm in order to determine its appropriate monetary recovery.
Therefore, we conclude that the district court properly determined that monetary
damages are not incidental to the requested equitable relief. DWFII cannot
establish that a class can be certified pursuant to Rule 23(b)(2).
III.
5
Finally, DWFII cannot show that “questions of law or fact common to class
members predominate over any questions affecting only individual members.”
FED. R. CIV. P. 23(b)(3). In order to determine whether common questions
predominate over individual questions, the court must consider “the claims,
defenses, relevant facts, and applicable substantive law.” Klay v. Humana, 382
F.3d 1241, 1254 (11th Cir. 2004), abrogated in part on other grounds by Bridge v.
Phoenix Bond & Indem. Co., 553 U.S. 639, 128 S. Ct. 2131 (2008) (internal
quotation marks and citation omitted). If class members must “still introduce a
great deal of individualized proof or argue a number of individualized legal points
to establish most or all of the elements of their individual claims,” then class
certification is not appropriate. Id. at 1255. As previously discussed, even if the
application of NCCI edits is completely prohibited by FLA. STAT. § 627.736 et
seq., individual questions remain because each individual provider must still prove
that it is entitled to reimbursement for the procedure that was either denied or
reimbursed at a reduced rate. See Klay, 382 F.3d 1241 (noting that a conspiracy to
underpay doctors and the programming of a computer system to achieve that goal
does not establish that individual doctors were underpaid on any specific
occasion). The adjudication of these individual questions clearly predominates
over any common questions that arise in this litigation.
6
IV.
For the foregoing reasons, we hold that the district court did not abuse its
discretion in denying DWFII’s motion for class certification. Therefore, we affirm
its order.
AFFIRMED.
7