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 : | M201677210 |
Claim Number : | CLFL2625A |
Date Submitted : | 2/17/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CENTURION MEDICAL LIABILITY PROTECTIVE RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1145017 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JAMES | BRENT | |||
Street Address | |||||
3100 SOUTH GESSNER ROAD SUITE 600 | |||||
City | State | Zip | |||
HOUSTON | TX | 77063 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 353 - 1639 | JBRENT@PROCLAIMAMERICA.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JASON | C | LEVINE | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 601 7TH STREET S | ||||
City | State | Zip Code | County | ||
ST PETERSBURG | FL | 33701 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL2625 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | MEDICAL DOCTOR | ||||
License Number | Specialty Code & Classification | Certification Number | |||
ME99461 |
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 | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
SUN COAST HOSPITAL | 100015 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/29/2011 | 7/17/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
CHEST PAIN AND SHORTNESS OF BREATH AND PAIN WHEN BREATHING | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
FAILURE TO TREAT. Death due to acute myocardial infarction and cardiogenic shock. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
PATIENT CODED WHILE WAITING ON ONCALL DOCTOR | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/11/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
During trial, but before court verdict. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
Directed verdict for plaintiff. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
1/12/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $40,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $103,798 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,509 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN AT THIS TIME |
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 : | M201678701 |
Claim Number : | CLFL2625C |
Date Submitted : | 6/9/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CENTURION MEDICAL LIABILITY PROTECTIVE RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1145017 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | LETIA | S | SHELTON | ||
Street Address | |||||
3100 SOUTH GESSNER ROAD SUITE 600 | |||||
City | State | Zip | |||
HOUSTON | TX | 77063 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 353 - 1624 | lshelton@proclaimamerica.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JASON | LEVINE | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 601 7th St S | ||||
City | State | Zip Code | County | ||
ST PETERSBURG | FL | 33701 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL2625 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME99461 | Cardiovascular Disease - No 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 | ||||
Other Outpatient Facility | OUTPATIENT FACILITY | ||||
Name of Institution | Code | ||||
SUNCOAST MEDICAL CLINIC | 233 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | PHYSICIANS OFFICE | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/29/2011 | 7/17/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Myocardial Infraction | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Myocardial Infraction | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
DEATH | |||||
Principal Injury Giving Rise To The Claim | |||||
DEATH | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
6/29/2011 | 12345678910 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 1/25/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
1/25/2016 |
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 | $106,195 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $40,000 | ||||||||||||||||||||
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 | |||||||||||||||||||||
NOT KNOWN AT THIS TIME |
Updates | |
No updates found. |
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Does Dr. JASON C LEVINE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JASON C LEVINE, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).