Department File Number : | M201781829 |
Claim Number : | 43341 |
Date Submitted : | 4/14/2017 |
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 | Sanjay | B | Shah | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 721 Oak Commons Blvd. | ||||
City | State | Zip Code | County | ||
Kissimmee | FL | 34741 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602744 02 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME88746 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Patient's Home | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Home | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/6/2011 | 12/6/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Phantom leg pain, chronic pain with stump, arthritis, back pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Prescribed narcotic pain medications | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to properly treat addiction and abuse of narcotic pain medications | |||||
Principal Injury Giving Rise To The Claim | |||||
Overdose | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/7/2013 | 2013-CA-001339 MP | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 4/3/2017 | ||||
Other Defendants Involved in this Claim | |||||
Khan, MD, Muhammad A Central Florida Internists | |||||
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 | |||||
4/3/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $117,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $135,485 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $73,893 | ||||||||||||||||||||
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 | |
No updates found. |
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Does Dr. SANJAY B SHAH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SANJAY B SHAH, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).