Department File Number : | M201679586 |
Claim Number : | 7030088836 |
Date Submitted : | 8/31/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LANDMARK AMERICAN INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
73-0994137 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jim | Dapolite | |||
Street Address | |||||
945 East Paces Ferry Rd, Suite 1800 | |||||
City | State | Zip | |||
Atlanta | GA | 30326 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 682 - 7683 | (404) 262 - 4437 | jdapolite@rsui.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kristy | L | Donnelly | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 6947 Merril Rd. | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32277 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
LHM826393 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Chiropractic Physician | ||||
License Number | Specialty Code & Classification | Certification Number | |||
CH10260 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/6/2015 | 6/3/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient presented for an elective cosmetic hair removal procedure using intense pulse light (IPL). The patient presented with intermittent dark, thick hairs on her chin that she wished to have permanently removed using the IPL technique. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Underwent IPL treatment. Doctor applied the standard "low" intensity of 19 joules in succession to areas of the patient's chin. Patient declined a "patch test", which is a single, short application of the IPL to an inconspicuous area to determine how the skin would react to the level of intensity, allowing for adjustments to be made based on the results. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleged that she incurred superficial first and (very small) second degree burns to her chin from the IPL treatment. These burns allegedly caused pain, blistering, scarring, hyperpigmentation, and subsequently, depression. | |||||
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 | 8/26/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
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? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $20,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Not known. |
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. KRISTY L DONNELLY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KRISTY L DONNELLY, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).