Department File Number : | M201680516 |
Claim Number : | 4189216132US |
Date Submitted : | 12/2/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
GRANITE STATE INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
02-0140690 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ashley | Weiss | |||
Street Address | |||||
3300 Business Park Dr | |||||
City | State | Zip | |||
Stevens Point | WI | 54482 | |||
Phone | Ext | Fax | E-Mail Address | ||
(715) 345 - 8606 | ashley.weiss@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mary | Wing | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8681 SW 89 Lane | ||||
City | State | Zip Code | County | ||
Gainesville | FL | 32608 | Alachua | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
089632708 | $500,000 | $1,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Registered Nurse | |||||
License Number | Specialty Code & Classification | Certification Number | |||
RN1178522 | Family Physicians or General Practitioners - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Alachua | ||||
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 | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/29/2015 | 6/21/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Vein treatment. Linear scar extending down lateral aspect of thigh. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Procedure for treatment of spider veins | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Leg was being prepped, the "needle" was still in her leg causing injury. | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/1/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
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 | $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 | |||||||||||||||||||||
N/A |
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. MARY WING, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARY WING, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).