| Department File Number : | M201886502 |
| Claim Number : | 155390-2 |
| Date Submitted : | 9/20/2018 |
| 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 | |||||
| 1100 Charlotte Ave, Ste 500 | |||||
| City | State | Zip | |||
| Nashville | TN | 37203 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 1779 | (615) 344 - 5889 | christina.stoker@hcahealthcare.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | LOIS | RANDALL | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2001 KINGSLEY AVE | ||||
| City | State | Zip Code | County | ||
| ORANGE PARK | FL | 32073 | Clay | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10114 | $5,000,000 | $10,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Other | REGISTERED NURSE | ||||
| License Number | Specialty Code & Classification | Certification Number | |||
| RN3064612 | |||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Clay | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| ORANGE PARK MEDICAL CENTER | 100226 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | CARDIAC CATH | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/18/2014 | 6/9/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| ELECTIVE LEFT CARDIAC CATHETERIZATION FOR EVALUATION AND/OR TREATMENT OF CHRONIC ANGINA. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| PATIENT UNDERWENT PROCEDURE WITH NO APPARENT COMPLICATIONS | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| PATIENT DEATH | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/22/2015 | 2015-CA-000908 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Clay | 8/27/2018 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 8/7/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $2 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $2 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| REFERRED TO RISK MANAGEMENT. NURSE MET STANDARDS OF CARE AND FOLLOWED ALL ORDERS. AMOUNT PAID ON BEHALF OF NURSE IS $1 BUT FL OIR WEBSITE DOES NOT ALLOW THAT AMOUNT TO BE ENTERED. | |||||||||||||||||||||
| 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. LOIS RANDALL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LOIS RANDALL, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).