Department File Number : | M201989326 |
Claim Number : | 123456 |
Date Submitted : | 7/15/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PAYNE, JENNIFER E | Primary | ||||
Insurer FEIN | Professional License Number | ||||
42-2237901 | ME118750 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jennifer | E | Payne | ||
Street Address | |||||
8333 North Davis Hwy 2nd Floor | |||||
City | State | Zip | |||
Pensacola | FL | 32514 | |||
Phone | Ext | Fax | E-Mail Address | ||
(985) 290 - 0931 | jennifer.payne2@hcahealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JENNIFER | E | PAYNE | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 8333 North Davis Hwy 2nd Floor | ||||
City | State | Zip Code | County | ||
Pensacola | FL | 32514 | Escambia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1 | $1 | $1 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME118750 | Surgery - Obstetrics - Gynecology | 9026493 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Escambia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
WEST FLORIDA REG. MED. CTR (PENSACOLA) | 100231 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/16/2015 | 9/15/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Left ovarian ruptured hemorrhagic cyst. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient alleged that, without authorization, physician discussed medical information in front of others, falsely stating patient had had a sexually transmitted disease in the past which caused lacerations in her uterus. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Patient alleged physician misdiagnosed the cause of her lacerations. | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleged to have suffered extreme humiliation and embarrassment and mental and emotional harm as a result of disclosure of false information about her health. | |||||
Severity Of Injury | |||||
Emotional Only - Fright, no physical damage |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/23/2017 | 2017-CA-000268 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Escambia | 7/1/2019 | ||||
Other Defendants Involved in this Claim | |||||
West Florida Internal Medicine, LLC West Florida Regional Medical Center | |||||
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 | ||||
Other | Settlement | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
6/18/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $7,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $7,500 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Training on use and disclosure of patient health information. |
Updates | |
No updates found. |
Does Dr. JENNIFER E PAYNE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JENNIFER E PAYNE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).