Department File Number : | M201781790 |
Claim Number : | F16-0106-B-14 |
Date Submitted : | 4/11/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Steven | R | Carey | ||
Street Address | |||||
4651 Salisbury Rd. Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 309 - 8127 | (904) 296 - 1245 | scarey@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sherry | Smith | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 4511 Sun N. Lake Blvd, Suite 104 | ||||
City | State | Zip Code | County | ||
Sebring | FL | 33875 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
10464 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9275163 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Highlands | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Examination Room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/10/2014 | 4/14/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with complaints of fainting, dizziness, and numbness in both feet for several days. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Treater ordered a CT scan of the head and a STAT cardiac evaluation. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleging a failure to treat TIA and CVA. | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient suffered a stroke. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/12/2016 | ||||
Other Defendants Involved in this Claim | |||||
Palosky, Eric | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
8/25/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $3,007 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of the case have been discussed with the insured and Risk Management. |
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. SHERRY SMITH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SHERRY SMITH, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).