Department File Number : | M201573706 |
Claim Number : | 1011381-01 |
Date Submitted : | 8/11/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Susan | K | Spielman | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | SHELLY | P | BAUMANN | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2700 University Square Drive | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33612 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
765775 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME42888 | Radiology - Diagnostic - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Tower Breast Diagnostic - Northside | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
8/12/2010 | 11/30/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Right breast mass | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Mammogram and ultrasound | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to timely diagnose cancer | |||||
Principal Injury Giving Rise To The Claim | |||||
Delay in diagnosis and treatment | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/28/2013 | 13-CA-009119 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 3/4/2015 | ||||
Other Defendants Involved in this Claim | |||||
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 | ||||
Other | Not Pursued | ||||
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 | $5,067 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,126 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 1/27/2016 2:48:13 PM | |||||||||
Reason for Change: | ALE UPDATE 1/27/2016 | |||||||||
| ||||||||||
Date of Change: | 8/11/2016 8:50:37 AM | |||||||||
Reason for Change: | ALE UPDATED 8/11/2016 | |||||||||
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Does Dr. SHELLY P BAUMANN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SHELLY P BAUMANN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).