Department File Number : | M201677655 |
Claim Number : | FP4405602 |
Date Submitted : | 3/22/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6614702 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | SELINA | C | CLOW | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1020 James Street | ||||
City | State | Zip Code | County | ||
Key West | FL | 33040 | Monroe | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-CL106633 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Physician Assistant | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9334752 | Hospitalists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Monroe | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Hospital/Institution | Lower Keys Medical Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/29/2012 | 2/12/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Aneurysm. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No operation or procedure caused the injury. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
The patient alleged failure to obtain family history and to do a LP that would have diagnosed the aneurysm. | |||||
Principal Injury Giving Rise To The Claim | |||||
Ruptured aneurysm. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/21/2013 | 13-CA001133K | ||||
County Suit Filed in | Date of Final Disposition | ||||
Monroe | 3/9/2016 | ||||
Other Defendants Involved in this Claim | |||||
Gajic, Zivko Ebhohimen, Charles Peki, Kostiya Atilla, Mehmet | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $67,542 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $53,335 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate |
Updates | |
No updates found. |
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Does Dr. SELINA C CLOW, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SELINA C CLOW, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).