Department File Number : | M201677771 |
Claim Number : | 144266 |
Date Submitted : | 4/1/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICUS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-5623491 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dionysia | Lawson | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Munsif | Ali | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 18550 Us Hwy 441 | ||||
City | State | Zip Code | County | ||
Mount Dora | FL | 32757 | Citrus | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL-16116278 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME111803 | Internal Medicine - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Citrus | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Outside of PCP's office | ||||
Name of Institution | Code | ||||
CITRUS MEMORIAL HOSPITAL | 100023 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/1/2013 | 6/22/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Estate of 73-year-old male Coumadin patient, with history of head trauma, alleges failure to order repeat CT Scan of head within 12-24 hours after initial study and negligent administration of heparin resulting in intracranial bleed. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
CT Scan of head | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Estate of 73-year-old male Coumadin patient, with history of head trauma, alleges failure to order repeat CT Scan of head within 12-24 hours after initial study and negligent administration of heparin resulting in intracranial bleed. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/7/2016 | ||||
Other Defendants Involved in this Claim | |||||
Shenai, Nisha Rasheed, Ameer Z |
|||||
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 | $5,522 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,274 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insured met conferenced with Calims Specialist and Defense Attorney |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims.
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