Department File Number : | M201575929 |
Claim Number : | 317044 |
Date Submitted : | 9/30/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6614702 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway W. Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Marcantel | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 410 Celebration Place, Suite 208 | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0950201 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68062 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
FLORIDA HOSPITAL-CELEBRATION HEALTH | 23960017 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/26/2012 | 4/7/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient was 25 weeks pregnant complained of chest pain was diagnosed with GERD. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent emergency C-section due to preeclampsia. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose and treat preeclampsia. | |||||
Principal Injury Giving Rise To The Claim | |||||
Bilateral retinopathy and developmental delays. | |||||
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 | ||||
9/12/2014 | 14-CA-2591-MP | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 8/31/2015 | ||||
Other Defendants Involved in this Claim | |||||
Florida Hospital | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $18,801 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $23,510 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201575930 |
Claim Number : | 320254 |
Date Submitted : | 9/30/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway W. Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Marcantel | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 410 Celebration Place, Suite 208 | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0950201 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68062 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
FLORIDA HOSPITAL-CELEBRATION HEALTH | 23960017 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
8/3/2009 | 7/8/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient was 40 weeks gestation presented with non-reassuring fetal monitoring strips. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Vaginal delivery. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to perform an emergency C-section in the presence of non-reassuring fetal monitoring strips. | |||||
Principal Injury Giving Rise To The Claim | |||||
Brain damage developmental delays. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/16/2014 | 2014-CA-2934-MP | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 8/31/2015 | ||||
Other Defendants Involved in this Claim | |||||
Florida Hospital | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $40,518 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $7,095 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
This page is not displaying certain sensitive information. |
Department File Number : | M201576543 |
Claim Number : | FP4429801 |
Date Submitted : | 12/14/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6614702 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway W. Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Marcantel | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 410 Celebration Place, Suite 208 | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-IN018790 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68062 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
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 | ||||
Other | Physicians Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/5/2011 | 5/14/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Full term pregnancy in a primiparious female. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Shoulder dystocia, labor & delivery attended by certified nurse midwife. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Brachial plexus injury to neonate. | |||||
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 | ||||
5/20/2013 | 2013 CA 001584MP | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 12/1/2015 | ||||
Other Defendants Involved in this Claim | |||||
Lowell, Amy Florid Hospital Celebration | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $99,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,473 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $17,988 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
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.
Department File Number : | M201680151 |
Claim Number : | 1032182-01 |
Date Submitted : | 9/13/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL FIRE & MARINE INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
47-6021331 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Myra | Lassen | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 463 - 3776 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | A | Marcantel | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 410 Celebration Place, Ste 208 | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ES010989 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68062 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
FLORIDA HOSPITAL-CELEBRATION HEALTH | 23960017 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/20/2014 | 3/9/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pregnancy | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Vaginal delivery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose macrosomia and cephalopelvic disproportion and treat by performing C-section | |||||
Principal Injury Giving Rise To The Claim | |||||
Increased risk for shoulder dystocia | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/26/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
Court Decision | Other | ||||
Other | Not Pursued | ||||
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 | $7,172 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | |||||||
Date of Change: | 9/13/2017 10:21:43 AM | ||||||
Reason for Change: | Updated ALE | ||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Department File Number : | M201884822 |
Claim Number : | 1029533-01 |
Date Submitted : | 9/25/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL FIRE & MARINE INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
47-6021331 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michelle | Pierron | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 463 - 3776 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | A | Marcantel | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 410 Celebration PL Ste 208 | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ES010989 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68062 | Surgery - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
FLORIDA HOSPITAL (ORLANDO) | 100007 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/9/2013 | 10/29/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Newborn | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Newborn care | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to recognize heart condition | |||||
Principal Injury Giving Rise To The Claim | |||||
Death of newborn | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/11/2016 | 2015-CA-002666 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 3/27/2018 | ||||
Other Defendants Involved in this Claim | |||||
Cantilli, Alexandria L Celebration Obstetrics and Gynecology Associates PA Pediatrics of Central Florida, PA Velez-Vega, Wilfredo Gowani, Nasima Adventist Health System/Sunbelt Inc dba FL Hosp of Orlando Adventist Health Systems/Sunbelt Inc. DBA FL Hosp Celebratio Gowani Medical Associates | |||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Summary judgment for the defendant. | |||||
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 | $12,009 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,140 | ||||||||||||||||||||
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 | |||||||||||||||||||||
NA |
Updates | ||||||||||
Date of Change: | 9/20/2018 3:40:46 PM | |||||||||
Reason for Change: | Incorrect limits provided originally. MP | |||||||||
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Date of Change: | 9/25/2018 4:18:52 PM | |||||||||
Reason for Change: | ALE update | |||||||||
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Does Dr. DAVID MARCANTEL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID MARCANTEL, MD has at least 6 medical malpractice case(s), lawsuit(s), or complaint(s).