Department File Number : | M201884429 |
Claim Number : | F12-0273-A-12 |
Date Submitted : | 2/27/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | Lance | |||
Street Address | |||||
4651 Salisbury Rd Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 309 - 8129 | jlance@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MANGALA | SHETTY | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1737A SE 28th Loop | ||||
City | State | Zip Code | County | ||
Ocala | FL | 34471 | Marion | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME75986 | Anesthesiology - Pain Management |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Marion | ||||
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 | ||||
9/27/2012 | 12/10/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Back Pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
epidural steroid injection of DepoMedrol | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
no misdiagnosis made | |||||
Principal Injury Giving Rise To The Claim | |||||
Pt injected with an allegedly contaminated steroid whichour insured received from a compounding pharmacy,accompanied by a certificate of sterility. Pt claimslasting complications including pain | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/13/2014 | 14-2662-CAG | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 12/31/2017 | ||||
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 | |||||
1/4/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $50,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $88,594 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Discussed case with insured. Will contact risk management if necessary |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201885937 |
Claim Number : | F12-0216-A-12 |
Date Submitted : | 7/16/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | Lance | |||
Street Address | |||||
4651 Salisbury Rd Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 616 - 3221 | jessicagrace88@gmail.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mangala | Shetty | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1737A SE 28th Loop | ||||
City | State | Zip Code | County | ||
Ocala | FL | 34471 | Marion | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME75986 | Anesthesiology - Pain Management |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Marion | ||||
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 | ||||
9/6/2012 | 10/22/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Back Pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
epidural steroid injection of DepoMedrol | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
no misdiagnosis made | |||||
Principal Injury Giving Rise To The Claim | |||||
Pt injected with an allegedly contaminated steroid which our insured received from a compounding pharmacy, accompanied by a certificate of sterility. Pt later suffered a stroke and passed away | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/29/2015 | 15-0021-CAG | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 6/28/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
After notice of appeal is filed or post judgment relief of action is required for recovery. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Judgment for the defendant. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $324,891 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Discussed cased with insured. Will contact risk management if necessary |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201676736 |
Claim Number : | 12-0252-A-12 |
Date Submitted : | 1/5/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tamla | Lloyd | |||
Street Address | |||||
4651 Salisbury Road, Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mangala | Shetty | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1737A S.E. 28th Loop | ||||
City | State | Zip Code | County | ||
Ocala | FL | 34471 | Marion | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME75986 | Anesthesiology - Pain Management |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Marion | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physician's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
8/15/2012 | 11/16/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient was initially referred to the insured for treatment of spinal pain after a motor vehicle accident. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient received epidural spinal injections. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None shown | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient allegedly received contaminated epidural injection from recalled lot. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/15/2012 | 12-4133-CA-G | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 12/21/2015 | ||||
Other Defendants Involved in this Claim | |||||
New England Compounding Pharmacy, Inc., a foreign corporati | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $7,823 | ||||||||||||||||||||
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 | |||||||||||||||||||||
The circumstances of this case were discussed with the insured and risk management was notified. Risk management discussed the case with the insured. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201676742 |
Claim Number : | 14-0017-A-12 |
Date Submitted : | 1/6/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tamla | Lloyd | |||
Street Address | |||||
4651 Salisbury Road, Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mangala | Shetty | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1737A S.E. 28th Loop | ||||
City | State | Zip Code | County | ||
Ocala | FL | 34471 | Marion | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME75986 | Anesthesiology - Pain Management |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Marion | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
OCALA REGIONAL MEDICAL CENTER | 100212 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physician's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
9/4/2012 | 1/23/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient was initially referred to the insured's with complaint of low back pain primarily on the left side. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient received different treatments from different physicians between 2003-2012. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None shown | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient allegedly received a contaminated epidural injection from recalled lot. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/22/2014 | 1:13-cv-12961 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 12/21/2015 | ||||
Other Defendants Involved in this Claim | |||||
Marion Pain Management Center, Inc. | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $32,213 | ||||||||||||||||||||
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 | |||||||||||||||||||||
The circumstances of this case were discussed with the insured and risk management was notified. Risk management discussed the case with the insured. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Does Dr. MANGALA SHETTY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MANGALA SHETTY, MD has at least 4 medical malpractice case(s), lawsuit(s), or complaint(s).