Department File Number : | M201573158 |
Claim Number : | 37686 |
Date Submitted : | 3/5/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michael | B | Esposito | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2120 Lakeland Hills Blvd. | ||||
City | State | Zip Code | County | ||
Lakeland | FL | 33805 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602675 04 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME64237 | Radiology - interventional |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
Lakeland Regional Medical Center | 100157 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/18/2010 | 6/1/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Cervical cancer | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
CT scan | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to dictate transcription of CT scan resulted in delay in diagnosis of cervical cancer | |||||
Principal Injury Giving Rise To The Claim | |||||
Cervical cancer | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/19/2012 | 53-2012-CA-006252 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 2/26/2015 | ||||
Other Defendants Involved in this Claim | |||||
Radiology Imaging Specialists of Lakeland Lakeland Regional Medical Center Wan, MD, Eric Florida EM-1 Medical Services | |||||
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 | |||||
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 | $110,448 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $16,734 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |||||||
Date of Change: | 3/5/2015 4:16:35 PM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 2/26/15 | ||||||
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Does Dr. MICHAEL B ESPOSITO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MICHAEL B ESPOSITO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).