| Department File Number : | M201576644 |
| Claim Number : | 132344 |
| Date Submitted : | 12/21/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICUS INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-5623491 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Dionysia | Lawson | |||
| Street Address | |||||
| 560 Davis Street | |||||
| City | State | Zip | |||
| San Francisco | CA | 94111 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Keith | Kim | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 410 Celebration Place, Suite 401 | ||||
| City | State | Zip Code | County | ||
| Celebration | FL | 34747 | Osceola | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL-16070927 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME88949 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Osceola | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| FLORIDA HOSPITAL-CELEBRATION HEALTH | 23960017 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/12/2012 | 7/22/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| umbilical hernia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| umbilical hernia repair | |||||
| Diagnostic Code : | 09 | ||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The Estate of a 53-year-old female alleges negligent performance of umbilical hernia repair resulting in delay in diagnosis of bowel perforation, sepsis and eventual death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 3/10/2014 | 2014-CA-000259 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Osceola | 9/17/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within 90 days of suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 10/1/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $375,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $101,471 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $31,515 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured met conferenced with Claims Specialist and Defense Attorney | |||||||||||||||||||||
| 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. KEITH KIM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KEITH KIM, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).