| Department File Number : | M201884682 |
| Claim Number : | 178699 |
| Date Submitted : | 8/3/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PROASSURANCE CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 38-2317569 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Denise | Stokes | |||
| Street Address | |||||
| 100 Brookwood Place | |||||
| City | State | Zip | |||
| Birmingham | AL | 35209 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (205) 802 - 4790 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Janet | K | Black | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 31860 US Hwy 19North | ||||
| City | State | Zip Code | County | ||
| Palm Harbor | FL | 34684 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP58849 | $10,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME71243 | Pediatrics - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/14/2010 | 6/4/2012 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Retinopathy of Prematurity | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| No operation, diagnostic or treatment procedure | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Blindness | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 3/4/2013 | 522013-CA002313XXCIC | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 3/1/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Foster, cherie D Mease Countryside Hospital specialty Eye Care Burns, Christine l Pediatrix Med Grp of FL dba Pediatrix Cardiology Palm Beach Razman, Dolores G Black, Janet K North Pinellas Childrens Medical Center christine L Burns, MD, PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| After court verdict and prior to filing of notice of appeal. | |||||
| Final Method of Claim Disposition | |||||
| Disposed of by Court | |||||
| Court Decision | Other | ||||
| Directed verdict for 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 | $88,902 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $50,683 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured discussed case with defense counsel, insurance personnel, and medical experts. | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 3/22/2018 1:21:42 PM | |||||||||
| Reason for Change: | Updated ALAE information | |||||||||
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| Date of Change: | 4/4/2018 1:40:54 PM | |||||||||
| Reason for Change: | Updated ALAE information | |||||||||
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| Date of Change: | 5/22/2018 4:18:16 PM | |||||||||
| Reason for Change: | update alae | |||||||||
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| Date of Change: | 5/23/2018 4:28:39 PM | |||||||||
| Reason for Change: | Updated ALAE information | |||||||||
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| Date of Change: | 7/10/2018 1:25:26 PM | |||||||||
| Reason for Change: | updated alae | |||||||||
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| Date of Change: | 8/3/2018 2:31:47 PM | |||||||||
| Reason for Change: | updated alae | |||||||||
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Does Dr. JANET K BLACK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JANET K BLACK, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).