Department File Number : | M201781532 |
Claim Number : | 49096 |
Date Submitted : | 3/24/2017 |
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 | Jeffrey | B | Robin | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1637 Kersley Circle | ||||
City | State | Zip Code | County | ||
Heathrow | FL | 32746 | Seminole | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1601847 08 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME78631 | Surgery - Opthalmology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Lasik Plus | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/29/2012 | 6/26/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
PRK vision correction | |||||
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 diagnose and treat blepharitis prior to performing PRK surgery | |||||
Principal Injury Giving Rise To The Claim | |||||
Right eye infection/severe corneal damage | |||||
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 | ||||
10/23/2014 | 2014-CA-7457 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 3/8/2017 | ||||
Other Defendants Involved in this Claim | |||||
Lasik Plus | |||||
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 | |||||
3/8/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $24,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $118,973 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $31,949 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |
No updates found. |
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Department File Number : | M201781623 |
Claim Number : | 2014-31-01-0015 |
Date Submitted : | 3/31/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PHYSICIANS INDEMNITY RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-5245060 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jaclyn | S | Adler | ||
Street Address | |||||
9300 NW 14th Street | |||||
City | State | Zip | |||
Pembroke Pines | FL | 33024 | |||
Phone | Ext | Fax | E-Mail Address | ||
(954) 559 - 3131 | (954) 431 - 8388 | Jadjuster2@aol.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jeffrey | B | Robin | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1637 Kersley Circle | ||||
City | State | Zip Code | County | ||
Heathrow | FL | 32746 | Seminole | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PIR100610-1-14 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME78631 | Ophthalmology - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
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 | ||||
Other | Physician's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/29/2012 | 7/2/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Myopia | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Photorefracive Keratectomy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose blepharitis | |||||
Principal Injury Giving Rise To The Claim | |||||
Bilateral dry eyes and corneal scarring | |||||
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 | ||||
11/6/2014 | 2014-CA-007457 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 3/8/2017 | ||||
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 | |||||
3/8/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $24,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $57,256 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A-insured followed standard of care |
Updates | |
No updates found. |
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Does Dr. JEFFREY B ROBIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JEFFREY B ROBIN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).