Department File Number : | M201988163 |
Claim Number : | 166390 |
Date Submitted : | 1/21/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christina | J | Stoker | ||
Street Address | |||||
2515 PARK PLAZA, BLDG 2-3E | |||||
City | State | Zip | |||
Nashville | TN | 37203 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 1779 | (866) 715 - 7235 | christina.stoker@hcahealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JON | S | METTERT | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1000 MARWALT DR | ||||
City | State | Zip Code | County | ||
FORT WALTON BEACH | FL | 32547 | Okaloosa | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10118 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS13240 | Emergency Medicine - Including Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Okaloosa | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
FORT WALTON BEACH MEDICAL CENTER | 100223 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | EMERGENCY ROOM | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/14/2018 | 11/26/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
PRESENTED WITH WORSENING COUGH AND CONGESTION; PREVIOUSLY DIAGNOSED WITH BRONCHITIS. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
EVALUATED; HAD CHEST XRAY, EKG AND LABS. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
PATIENT DEATH FROM CARDIAC ISSUES. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 2/15/2019 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
1/7/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $2,340 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,600 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $200,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
REFERRED TO RISK MANAGEMENT. |
Updates | |
No updates found. |
Does Dr. JON S METTERT, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JON S METTERT, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).