Department File Number : | M202091284 |
Claim Number : | 61832 |
Date Submitted : | 1/29/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tonya | Ponder | |||
Street Address | |||||
3535 Piedmont Rd., NE, Bldg. 14 - Ste. 1000 | |||||
City | State | Zip | |||
Atlanta | GA | 30305 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 842 - 5556 | tponder@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jeremy | D | Havas | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1902 Westover Reserve Blvd. | ||||
City | State | Zip Code | County | ||
Windermere | FL | 34786 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1616055 05 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7352 | Radiology - Diagnostic - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Triumph Radiology Associates, PA | ||||
Name of Institution | Code | ||||
FLORIDA HOSPITAL - KISSIMMEE | 100089 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/10/2015 | 4/24/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Fall and injury to right side with dizziness and stiffness in the shoulder and neck. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
X-ray reading | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose ankylosing spondylitis, nuchal ligament ossification and a fracture at the C5 level w/ kyphosis and bilateral jumped facets at C4-5 level. | |||||
Principal Injury Giving Rise To The Claim | |||||
Cervical spine fracture | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/20/2017 | 2017-CA-002923 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 12/10/2019 | ||||
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 | |||||
12/10/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $113,381 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $47,412 | ||||||||||||||||||||
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. |
Does Dr. JEREMY D HAVAS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JEREMY D HAVAS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).