Department File Number : | M201679265 |
Claim Number : | 22577-01 |
Date Submitted : | 7/26/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PODIATRY INSURANCE COMPANY OF AMERICA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1403235 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Karen | Kessler | |||
Street Address | |||||
3000 Meridian Blvd., Suite 400 | |||||
City | State | Zip | |||
Franklin | TN | 37067 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 371 - 8776 | 2249 | kkessler@picagroup.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Andre | M | Williams | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 352 Milus St. | ||||
City | State | Zip Code | County | ||
Punta Gorda | FL | 33950 | Charlotte | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1PD0026675 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO3153 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Charlotte | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
5/8/2015 | 6/11/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Ingrown toenail, right hallux | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Nail debrided and resected | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient was upset that a nail was taken off and that might expose her to infection as she is going on a mission trip to Africa. She asked for the doctor to pay for her trip and if he does not do so she will bring a lawsuit when she returns. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 7/5/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $1,421 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $124 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
None - Specialty code #80993 |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. ANDRE M WILLIAMS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANDRE M WILLIAMS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).