Department File Number : | M201574071 |
Claim Number : | 08-08-0083-A |
Date Submitted : | 4/2/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tamla | N | Lloyd | ||
Street Address | |||||
4651 Salisbury Road, Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dudley | Teel | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1000 36th Street | ||||
City | State | Zip Code | County | ||
Vero Beach | FL | 32960 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
GL01000054 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44584 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
INDIAN RIVER MEMORIAL HOSPITAL | 100105 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Indian River Memorial Hospital | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/11/2008 | 9/26/2008 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient arrived at Indian River ER via EMS suffering from diabetic ketoacidosis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Saline bolus and insulin administered to patient. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None made. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to timely, adequately and properly treat patient's DKA, resulting in brainstem herniation. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/11/2015 | 10-60481 CA 11 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Indian River | 3/11/2015 | ||||
Other Defendants Involved in this Claim | |||||
Indian River Memorial Hospital, Inc. | |||||
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 | |||||
3/11/2015 |
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 | $160,662 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Circumstances of this case have been discussed with the insured and risk management was notified. Risk management has discussed case with the insured. |
Updates | |
No updates found. |
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Department File Number : | M201781624 |
Claim Number : | F08-08-0083-A |
Date Submitted : | 3/31/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dionysia | Lawson | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dudley | Teel | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1000 36th Street | ||||
City | State | Zip Code | County | ||
vero Beach | FL | 32960 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
GL01000054 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44584 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
INDIAN RIVER MEMORIAL HOSPITAL | 100105 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/11/2008 | 9/26/2008 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient arrived at Indian River ER via EMS suffering from diabetic ketoacidosis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Saline bolus and insulin administered to patient. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
no misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to timely,adequately and properly treat patient's DKA, resulting in brainstem herniation. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/16/2010 | 312010CA073141 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Indian River | 3/15/2015 | ||||
Other Defendants Involved in this Claim | |||||
Indian River Memorial Hospital, Inc. | |||||
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 | |||||
Disposed of by Court | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
3/11/2015 |
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 | $160,662 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of this case have been discussed with the insured and risk management was notified.Risk management has discussed case with the insured. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201576381 |
Claim Number : | 44840 |
Date Submitted : | 2/4/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | DUDLEY | G | TEEL | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1720 S. Cook Ave. | ||||
City | State | Zip Code | County | ||
Orlando | FL | 32806 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602844 01 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44584 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
INDIAN RIVER MEMORIAL HOSPITAL | 100105 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/18/2012 | 5/16/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Traumatic eye injury | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to properly evaluate eye and refer for ophthalmic evaluation | |||||
Principal Injury Giving Rise To The Claim | |||||
Blindness in one eye | |||||
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 | ||||
1/20/2014 | 312014CA000005 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Indian River | 1/20/2016 | ||||
Other Defendants Involved in this Claim | |||||
Smith, ARNP, Mechele Indian River Medical Center Emergency Physicians of Central Florida Chiappa Firearms Sebastian Ammo | |||||
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 | ||||
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 | $44,785 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $14,055 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counsled insured |
Updates | |||||||
Date of Change: | 2/4/2016 1:12:21 PM | ||||||
Reason for Change: | Report upated to reflect Court Document final disposition date of 01/20/16 | ||||||
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Does Dr. DUDLEY TEEL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DUDLEY TEEL, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).