Department File Number : | M201679292 |
Claim Number : | 1021579-02 |
Date Submitted : | 8/17/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Amy | Chung | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 206 2nd Street East | ||||
City | State | Zip Code | County | ||
Bradenton | FL | 34208 | Manatee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
762914 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS13875 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Manatee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MANATEE MEMORIAL HOSPITAL | 100035 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/14/2012 | 10/16/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Piece of chicken lodged in esophagus | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Admit to hospital; monitor | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Administering food and liquids by mouth in a NPO patient | |||||
Principal Injury Giving Rise To The Claim | |||||
Esophageal perforation; respiratory distress causing permanent injury | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/17/2015 | 2015 CA 001278 AX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Manatee | 7/21/2016 | ||||
Other Defendants Involved in this Claim | |||||
Manatee Memorial Hospital LP dba Manatee Memorial Health Sys Kocab MD, Mark Suncoast GI Associates LLC Florida Digestive Health Specialists LLP | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
7/20/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $45,319 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $15,733 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 2/20/2017 3:28:04 PM | |||||||||
Reason for Change: | ALE UPDATE 2/20/2017 | |||||||||
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Date of Change: | 8/17/2017 3:00:44 PM | |||||||||
Reason for Change: | ALE UPDATE 8/17/2017 | |||||||||
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Does Dr. AMY CHUNG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. AMY CHUNG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).