Department File Number : | M201884844 |
Claim Number : | 71HLC10003836701 |
Date Submitted : | 3/28/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
West Coast Neonatalology, Inc. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-339830 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Patricia | M | Condon | ||
Street Address | |||||
501 6th Avenue South | |||||
City | State | Zip | |||
St Petersburg | FL | 33701 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 767 - 4287 | (727) 767 - 8597 | pcondon1@jhmi.edu |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Van | S | Lilly | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 501 6th Avenue South | ||||
City | State | Zip Code | County | ||
St. Petersburg | FL | 33701 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HLC 10003836700 | $3,000,000 | $20,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME45834 | Neonatal/Perinatal Medicine |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Manatee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MANATEE MEMORIAL HOSPITAL | 100035 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Nursery | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/7/2010 | 4/1/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
respiratory distress and suspected sepsis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
intubation | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis was made | |||||
Principal Injury Giving Rise To The Claim | |||||
vocal cords damaged | |||||
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 | ||||
7/23/2013 | 2013 CA 004640 AX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Manatee | 11/7/2017 | ||||
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 | |||||
11/7/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $390,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $202,699 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
settlement without admission of liability |
Updates | |
No updates found. |
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Does Dr. VAN S LILLY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. VAN S LILLY, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).