Department File Number : | M201886388 |
Claim Number : | SHI-16-355252 |
Date Submitted : | 9/12/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Sheridan Healthcorp, Inc. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-0971075 | |||||
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 | WILLIAM | F | VON BARGEN | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 760 S. VOLUSIA AVE #100 | ||||
City | State | Zip Code | County | ||
ORANGE CITY | FL | 34474 | Marion | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HAZ4032218126-1 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS9286 | Emergency Medicine - Including Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Marion | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
WEST MARION COMMUNITY HOSPITAL | 23960039 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/2/2016 | 12/20/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
CERVICAL EPIDURAL ABSCESS | |||||
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 TIMELY DIAGNOSE AND TREAT | |||||
Principal Injury Giving Rise To The Claim | |||||
INCOMPLETE PARAPLEGIA | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/4/2017 | 17 CA 001483 AX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 8/14/2018 | ||||
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 | |||||
8/9/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $925,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $26,813 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $12,083 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN |
Updates | |
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Does Dr. WILLIAM F VON BARGEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILLIAM F VON BARGEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).