Department File Number : | M201884289 |
Claim Number : | 25055-01 |
Date Submitted : | 2/9/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PODIATRY INSURANCE COMPANY OF AMERICA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1403235 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Angeline | Schave | |||
Street Address | |||||
3000 Meridian Blvd. Ste. 400 | |||||
City | State | Zip | |||
Franklin | TN | 37067 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 371 - 8776 | 2998 | (615) 986 - 1945 | aschave@picagroup.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Shayne | R | Jensen | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2201 Jenks Avenue | ||||
City | State | Zip Code | County | ||
Panama City | FL | 32405 | Bay | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1PD0015887 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO2867 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Bay | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
PANAMA CITY SURGERY CENTER | 14960494 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/9/2015 | 2/27/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Exostectomy of the hallux; Bunion deformity with osteochondral defect of the 1st metatarsophalangeal joint with microfracture performed over the 1st metatarsal head; Deformity of hallux with Akin osteotomy performed; long 2nd metatarsal with capsulitis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Austin and Akin with McBride; Exostectomy of the hallux; hammertoe repair with arthroplasty/ arthrodesis of the 2nd and 3rd proximal interphalangeal joint; Weil osteotomy of the 2nd metatarsal. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleges hammertoe deformity has recurred. No deviation from the standard of care was proven. | |||||
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 | 1/27/2018 | ||||
Other Defendants Involved in this Claim | |||||
Hodson, Larry L | |||||
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 | $6,153 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,350 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Specialty Code - 80993 |
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. SHAYNE R JENSEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SHAYNE R JENSEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).