Department File Number : | M201680069 |
Claim Number : | CORP-15-317115 |
Date Submitted : | 10/20/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
TEAM HEALTH, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
62-1562558 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | TODD | BERGAN | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1987 EAST C-476 | ||||
City | State | Zip Code | County | ||
BUSHNELL | FL | 33513 | Citrus | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
6797715 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | PA | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9102600 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Citrus | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Hospital/Institution | SEVEN RIVERS REGIONAL MEDICAL CENTER | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/10/2014 | 9/9/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
SPINAL CORD HEMATOMA | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEEN IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
FAILURE TO DIAGNOSE SPINAL CORD HEMATOMA | |||||
Principal Injury Giving Rise To The Claim | |||||
PARTIAL QUADRIPLEGIC | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/11/2016 | 2016 ca 0000 18a | ||||
County Suit Filed in | Date of Final Disposition | ||||
Citrus | 10/20/2016 | ||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
10/6/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $1,250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $36,370 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $28,387 | ||||||||||||||||||||
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 | |||||||||||||||||||||
unknown |
Updates | |
No updates found. |
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Department File Number : | M201679800 |
Claim Number : | 5866529554US a |
Date Submitted : | 9/29/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LEXINGTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-1149494 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | carolyn | r | ewell | ||
Street Address | |||||
17200 W 119th St | |||||
City | State | Zip | |||
Olathe | KS | 66061 | |||
Phone | Ext | Fax | E-Mail Address | ||
(913) 495 - 4217 | carolynranee.ewell@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Todd | Bergan | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 6201 N Suncoast Blvd | ||||
City | State | Zip Code | County | ||
Crystal River | FL | 34428 | Citrus | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
6797715 | $3,000,000 | $80,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Physician Assistant | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9102600 | Emergency Medicine - Including Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Citrus | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
SEVEN RIVERS COMMUNITY HOSPITAL | 100249 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/10/2014 | 9/24/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The ER staff this time repeated her INR test and found that it was greater than 10.Mrs. Spiller had to be intubated in the ER. Tests revealed that she had a bleed in her cervical spine,which caused a hematoma to press on her spine and cause her quadriplegia. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient was sent to Seven Rivers emergency department to have her INR checked emergently and to be given a vitamin K shot to reverse her excessively high INR, the blood test used to monitor the levels of Coumadin in the blood by measuring how long it takes for the blood to clot. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Despite the diffuse body aches and the darker than normal urine and stool, Mr. Bergan did not repeat the INR test to see if it was still high and he did not investigate in any manner to see if she had an internal bleed | |||||
Principal Injury Giving Rise To The Claim | |||||
69, Female, alleging failure to diagnose spinal cord hematoma resulting in return to emergency department next day, emergent surgery & partial quadriplegic. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/11/2016 | 2016 CA 000018 A | ||||
County Suit Filed in | Date of Final Disposition | ||||
Citrus | 9/23/2016 | ||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
9/23/2016 |
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,025 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | |
No updates found. |
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Does Dr. TODD BERGAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. TODD BERGAN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).