Department File Number : | M201883990 |
Claim Number : | 59035 |
Date Submitted : | 1/5/2018 |
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 | (404) 842 - 3319 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Eric | H | Schallen | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 33599 University Blvd., S. Bldg. 300 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32216 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1600004 19 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME87153 | Radiology - Diagnostic - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
BAPTIST MEDICAL CENTER SOUTH | 23960052 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/4/2014 | 8/30/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Acute onset right lower back pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Kyphoplasty | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to properly perform procedure | |||||
Principal Injury Giving Rise To The Claim | |||||
Hematoma | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/21/2017 | 16-2016-CA-003767 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 12/6/2017 | ||||
Other Defendants Involved in this Claim | |||||
Shirley, MD, Steve A Gesner, MD, Douglas E Spohr, MD, Clifford H Drs. Mori , Bean & Brooks, PA | |||||
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 | $10,609 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,229 | ||||||||||||||||||||
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 counseled insured |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Does Dr. ERIC H SCHALLEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ERIC H SCHALLEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).