Department File Number : | M201884750 |
Claim Number : | 2015-08-221-027 |
Date Submitted : | 3/20/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Lexington Insurace Company | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-114949 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | Hayden | |||
Street Address | |||||
2985 Drew Street | |||||
City | State | Zip | |||
Clearwater | FL | 33764 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 519 - 1268 | jessica.hayden@baycare.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Siambanes | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 4815 W Beachway Drive | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33609 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1120-73-195 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS10633 | Surgery - Orthopedic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/10/2015 | 11/11/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Bilateral pes Plano valgus was noted and surgical correction was discussed. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Distal tibia osteotomy with internal fixation bilaterallyBilateral calcaneal osteotomyBilateral first cuneiform osteotomyBilateral gastrocnemius open lengtheningBilateral posterior tibial tendon shortening | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient was taken to surgery June 10, 2015. Post operatively the patient¿s foot sustained an infection and casting was removed. The infection resolved. Bracing was applied following surgery. By September 17, 2015 the patient had a loss of surgical correction which is a known complication of this procedure. Allegations include recommending surgery to correct the patient¿s feet without the appropriate basis to do so and negligently performing the surgery. As a result of the alleged negligence it is alleged further that the patient was injured in and about his feet, ankles and legs, etc. | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/13/2016 | 16-CI-004297 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 2/28/2018 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
2/28/2018 |
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 | $89,160 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Any risk issues have been/will be addressed. |
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. DAVID SIAMBANES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID SIAMBANES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).