Department File Number : | M201677534 |
Claim Number : | HPT 1480 |
Date Submitted : | 3/10/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Martin, Jeffrey W | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-1281292 | ME83250 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Carol | Wiseheart | |||
Street Address | |||||
747 S. Ridgewood Ave., Suite 111 | |||||
City | State | Zip | |||
Daytona Beach | FL | 32114 | |||
Phone | Ext | Fax | E-Mail Address | ||
(386) 310 - 7969 | (386) 310 - 7973 | cwiseheart@halifaxins.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jeffrey | W | Martin | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1075 Mason Ave. | ||||
City | State | Zip Code | County | ||
Daytona Beach | FL | 32117 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
02-97 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME83250 | Surgery - Orthopedic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Volusia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
HALIFAX MEDICAL CENTER | 100017 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/11/2013 | 4/30/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Right Femoral Neck Fracture | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Right Bipolar Hemiarthroplasty | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged delay of identification and treatment of wound infection. | |||||
Principal Injury Giving Rise To The Claim | |||||
Wound infection | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 7/30/2015 | ||||
Other Defendants Involved in this Claim | |||||
Halifax Medical Center | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
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 | $3,448 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,250 | ||||||||||||||||||||
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 | |||||||||||||||||||||
On going risk management |
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.
Does Dr. JEFFREY W MARTIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JEFFREY W MARTIN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).