Medical Malpractice Cases

Medical Malpractice Cases In Citrus County Florida

Dr. TODD BERGAN Medical Malpractice Lawsuits - Court Case # 2016 ca 0000 18a

Indemnity Paid: $1,250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
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    

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

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
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
unknown
 
Updates
 
No updates found.

 

 

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Dr. Brandon W Covert Medical Malpractice Lawsuits - Court Case # 15-000473 CA (A)

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201679753
Claim Number : 1028151-01
Date Submitted : 8/22/2017
 
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 Lynn Louthan
Street Address
5814 Reed Road
City State Zip
Ft Wayne IN 46835
Phone Ext Fax E-Mail Address
(260) 486 - 0778     reportaclaim@medpro.com
 
Insured Information
 
Type First Name MI Last Name
Individual Brandon W Covert
Insurer Type Street Address of Practice
Licensed c/o Citrus Memorial Hospital, 502 W Highland Blvd
City State Zip Code County
Inverness FL 34452 Citrus
Policy Number Per Claim Policy Limits Aggregate Policy Limits
766923 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Osteopathic Physician  
License Number Specialty Code & Classification Certification Number
OS9984 Radiology - Diagnostic - Minor Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  M Citrus
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
CITRUS MEMORIAL HOSPITAL 100023
Location of Institutional Injury Other Location of Institutional Injury
Radiology, Emergency Room  
Date of Occurrence Date Reported to Insurer
7/1/2013 9/8/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient on Coumadin; fell and hit head
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Interpreted CT of head
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to identify subdural hematoma
Principal Injury Giving Rise To The Claim
Patient died 3 days later after second fall at hospital
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
11/30/2015 15-000473 CA (A)
County Suit Filed in Date of Final Disposition
Citrus 9/16/2016
Other Defendants Involved in this Claim
Citrus Memoral Health System
Associated Radiologists of Inverness PA
Parikh MD, Bharat
Citrus Neuroscience Institute PA
Nerella MD, Nishant
Citrus Cardiology Consultants
Kim MD, Peter
Ocala Heart Institute Inc
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
9/15/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $500,000
Loss Adjust Expense Paid to Defense Counsel $18,772
All Other Loss Adjustment Expense Paid $4,106
Injured Person's Total Non-Economic Loss $440,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
 
Date of Change: 8/22/2017 2:40:49 PM
Reason for Change: ALE UPDATE 8/22/2017
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 13279 18772
All Other Loss Adjustment Expense Paid 3653 4106

 

 

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Dr. CARLOS A POTTINGER Medical Malpractice Lawsuits - Court Case # 2017-CA-000905

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201887014
Claim Number : 162115
Date Submitted : 11/14/2018
 
Insurer Information
 
Insurer Name Coverage Type
HEALTH CARE INDEMNITY, INC. Primary
Insurer FEIN Professional License Number
61-0904881  
Insurer Contact Information
Type First Name MI Last Name
Individual Christina J Stoker
Street Address
1100 Dr. Martin Luther King Jr. Blvd, Ste. 500
City State Zip
Nashville TN 37203
Phone Ext Fax E-Mail Address
(615) 344 - 1779   (866) 715 - 7235 christina.stoker@hcahealthcare.com
 
Insured Information
 
Type First Name MI Last Name
Individual CARLOS A POTTINGER
Insurer Type Street Address of Practice
Licensed 2206 WILBORN AVE MOB 1
City State Zip Code County
SOUTH BOSTON VA 24592 Out of state
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HCI-10116 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME103639 Surgery - Obstetrics - Gynecology  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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
Hospital Inpatient Facility  
Name of Institution Code
CITRUS MEMORIAL HOSPITAL 100023
Location of Institutional Injury Other Location of Institutional Injury
Labor and Delivery Room  
Date of Occurrence Date Reported to Insurer
12/26/2016 7/28/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
PRESENTED WITH ABDOMINAL PAIN AT 31 WEEKS GESTATION.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
LABOR AND DELIVERY.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
EMERENCY C-SECTION; UTERINE RUPTURE AND FETAL DEMISE.
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
12/29/2017 2017-CA-000905
County Suit Filed in Date of Final Disposition
Citrus 10/18/2018
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 not subject to Arbitration.
Date of Payment
10/5/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $500,000
Loss Adjust Expense Paid to Defense Counsel $44,973
All Other Loss Adjustment Expense Paid $9,355
Injured Person's Total Non-Economic Loss $494,918
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $5,082 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
REFERRED TO RISK MANAGEMENT.
 
Updates
 
No updates found.

 

 

*NR: Prior to 04/28/1999 this field was not required in submitted claims.

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Dr. HARRIETT SMITH-MCKINNEY Medical Malpractice Lawsuits - Court Case # 2007 CA 5316

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200951973
Claim Number :EMC-AO-07-70617
Date Submitted :1/6/2009
 
Insurer Information
 
Insurer NameCoverage Type
CONTINENTAL CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
36-2114545 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancyJThomas
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualHARRIETT SMITH-MCKINNEY
Insurer TypeStreet Address of Practice
Licensed32511 Timber Lake Drive
CityStateZip CodeCounty
Mount DoraFL32759Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ1040025381-5$250,000$750,000
Profession or BusinessOther Profession or Business
OtherPhysician Assistant
License NumberSpecialty Code & ClassificationCertification Number
PA2621  

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
3/8/20054/17/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Severe hypertension, rash
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to order more extensive testing, failure to admit
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Treatment related
Principal Injury Giving Rise To The Claim
Bilateral nephrectomy
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/15/20072007 CA 5316
County Suit Filed inDate of Final Disposition
Citrus12/31/2008
Other Defendants Involved in this Claim
Citrus Memorial Hospital
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
11/11/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$0
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
NA
 
Updates
 
No updates found.

 

 

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Dr. Patrick Jean Medical Malpractice Lawsuits - Court Case # 2007 CA 5316

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200951974
Claim Number :EMC-FL-07-68372
Date Submitted :1/6/2009
 
Insurer Information
 
Insurer NameCoverage Type
CONTINENTAL CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
36-2114545 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancyJThomas
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualPatrick Jean
Insurer TypeStreet Address of Practice
Licensed3198 CR 575
CityStateZip CodeCounty
BushnellFL33513Sumter
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ1040025381-5$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME38598Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
3/8/20054/17/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Severe hypertension, rash
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to order more extensive testing, failure to admit
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Treatment related
Principal Injury Giving Rise To The Claim
Bilateral nephrectomy
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/15/20072007 CA 5316
County Suit Filed inDate of Final Disposition
Citrus12/31/2008
Other Defendants Involved in this Claim
Citrus Memorial Hospital
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
11/11/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$0
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown
 
Updates
 
No updates found.

 

 

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Dr. Harold Bradfield Medical Malpractice Lawsuits - Court Case # 2010 CA 1131

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201057720
Claim Number :LTC-CAPT-93815
Date Submitted :6/28/2010
 
Insurer Information
 
Insurer NameCoverage Type
Jackson Healthcare, Inc.Primary
Insurer FEINProfessional License Number
81-0652936 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancyJThomas
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualHarold Bradfield
Insurer TypeStreet Address of Practice
Self-Insurer4533 39th Street South
CityStateZip CodeCounty
St. PetersburgFL33711Pinellas
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
2009-2010$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME78650Radiology - Diagnostic - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
4/29/200612/3/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Head injury after jumping over wall
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
CT scan reviewed by subject of this report
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose
Principal Injury Giving Rise To The Claim
Failure to diagnose brain tumor
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/25/20102010 CA 1131
County Suit Filed inDate of Final Disposition
Citrus6/23/2010
Other Defendants Involved in this Claim
Citrus Memorial Hospital
Stage of Legal System at which Settlement was Reached or Award Made
After court verdict and prior to filing of notice of appeal.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
Directed verdict for plaintiff. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
5/21/2010
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$37,019
All Other Loss Adjustment Expense Paid$1,438
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown.
 
Updates
 
No updates found.

 

 

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Dr. Eric W Hirsch Medical Malpractice Lawsuits - Court Case # 2013-CA-000167A

Indemnity Paid: $495,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201368422
Claim Number :37899/41327
Date Submitted :11/26/2013
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualEricWHirsch
Insurer TypeStreet Address of Practice
LicensedPO Box 1990
CityStateZip CodeCounty
Crystal RiverFL34423Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1616017 02$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME95650Surgery - Orthopedic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
4/26/20116/23/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Vascular complication following knee revision surgery.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to timely diagnose and treat vascular complication.
Principal Injury Giving Rise To The Claim
Above the knee amputation.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/25/20132013-CA-000167A
County Suit Filed inDate of Final Disposition
Citrus11/15/2013
Other Defendants Involved in this Claim
Citrus Orthopaedic & Joint Institute
Citrus Memorial Hospital
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
9/6/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$495,000
Loss Adjust Expense Paid to Defense Counsel$24,063
All Other Loss Adjustment Expense Paid$11,050
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$305,000$0
Wage Loss$0$0
Other Expenses$0$400,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured.
 
Updates
 
 
Date of Change:11/26/2013 11:49:50 AM
Reason for Change:Report udpated to reflect Court Document final disposition date of 11/15/13
 
Field ChangedFormer ValueNew Value
Date of Final Disposition06-SEP-1315-NOV-13

 

 

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Dr. Jayanth G Rao Medical Malpractice Lawsuits - Court Case # 2017-CA-000700A

Indemnity Paid: $450,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201987602
Claim Number : 61958
Date Submitted : 1/15/2019
 
Insurer Information
 
Insurer Name Coverage Type
MAG MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
58-1449198  
Insurer Contact Information
Type Entity Name
Entity MAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
City State Zip
Orlando FL 32819
Phone Ext Fax E-Mail Address
(407) 370 - 3813   (404) 842 - 3319 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Jayanth G Rao
Insurer Type Street Address of Practice
Licensed 3201 SW 33rd Rd
City State Zip Code County
Ocala FL 34474 Marion
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1616056 06 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME65465 Radiation Therapy  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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 Outpatient Facility Florida Regional Cancer Center
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
8/22/2014 5/2/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Skin cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Re-radiating previously treated areas
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to provide safe radiation treatment
Principal Injury Giving Rise To The Claim
Osteomyelitis and left BKA
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
8/28/2017 2017-CA-000700A
County Suit Filed in Date of Final Disposition
Citrus 10/29/2018
Other Defendants Involved in this Claim
21st Century Oncology
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
10/29/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $450,000
Loss Adjust Expense Paid to Defense Counsel $59,152
All Other Loss Adjustment Expense Paid $22,248
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $300,000 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
No updates found.

 

Dr. Rafik Abadier Medical Malpractice Lawsuits - Court Case # 2005CA 3977

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200743911
Claim Number :A05-32494-03
Date Submitted :1/12/2007
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCheriMMontague
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRafik Abadier
Insurer TypeStreet Address of Practice
Licensed308 W Highland Blvd.
CityStateZip CodeCounty
InvernessFL34452Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
28009$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME59443Cardiovascular Disease - No Surgery80422

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
9/13/20035/9/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Treatment was sought for chest pain of unknown etiology.Patient diagnosed with atypical chest pain, ruled out acute myocardial infarction.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Intra-arterial injection of phenergan by nursing staff.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged delay in diagnosis and treatment of intra-arterial injection of phenergan.
Principal Injury Giving Rise To The Claim
Amputation of right hand.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/26/20052005CA 3977
County Suit Filed inDate of Final Disposition
Citrus12/22/2006
Other Defendants Involved in this Claim
Citrus Cardiology Consultants
Citrus Memorial Hospital
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/22/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$400,000
Loss Adjust Expense Paid to Defense Counsel$23,024
All Other Loss Adjustment Expense Paid$17,631
Injured Person's Total Non-Economic Loss$400,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Walter Choung Medical Malpractice Lawsuits - Court Case # 2011 3097

Indemnity Paid: $375,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263759
Claim Number :41487-01
Date Submitted :5/2/2012
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualWalter Choung
Insurer TypeStreet Address of Practice
LicensedP.O. Box 640580
CityStateZip CodeCounty
Beverly HillsFL34464Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
44783$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME66779Surgery - Orthopedic80154

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
3/10/20083/28/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Gangrene, right foot.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Right bunionectomy, metatarsal head resection toes 2-5, hammer toe correction, toes 2 & 3.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Alleged delay in diagnosis and treatment of gangrene, resulting in partial amputation of right foot.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/9/20112011 3097
County Suit Filed inDate of Final Disposition
Citrus4/11/2012
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
4/11/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$375,000
Loss Adjust Expense Paid to Defense Counsel$10,770
All Other Loss Adjustment Expense Paid$5,116
Injured Person's Total Non-Economic Loss$375,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Scott R Fisher Medical Malpractice Lawsuits - Court Case # 2012-CA-802

Indemnity Paid: $350,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201573396
Claim Number : 38660
Date Submitted : 2/6/2015
 
Insurer Information
 
Insurer Name Coverage Type
MAG MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
58-1449198  
Insurer Contact Information
Type Entity Name
Entity MAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
City State Zip
Orlando FL 32819
Phone Ext Fax E-Mail Address
(407) 370 - 3813   (407) 370 - 2247 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Scott R Fisher
Insurer Type Street Address of Practice
Licensed 922 N. Citrus Ave.
City State Zip Code County
Crystal River FL 34428 Citrus
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1616005 02 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME70251 Radiology - Diagnostic - Minor Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  M Citrus
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Outpatient Facility Citrus Diagnostic Center
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Radiology, Emergency Room  
Date of Occurrence Date Reported to Insurer
12/8/2009 9/13/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Ewing's sarcoma
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose Ewing's sarcoma on MRI
Principal Injury Giving Rise To The Claim
Ewing's sarcoma
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
5/17/2012 2012-CA-802
County Suit Filed in Date of Final Disposition
Citrus 1/8/2015
Other Defendants Involved in this Claim
Citrus Diagnostic Center
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
1/8/2015
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $350,000
Loss Adjust Expense Paid to Defense Counsel $54,778
All Other Loss Adjustment Expense Paid $39,100
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $200,000 $0
Wage Loss $0 $0
Other Expenses $8,000 $5,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Komala N Bhushan Medical Malpractice Lawsuits - Court Case # 2005-CA-3806

Indemnity Paid: $350,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200848768
Claim Number :20340
Date Submitted :8/12/2008
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKomalaNBhushan
Insurer TypeStreet Address of Practice
LicensedHighway 491 Suite 512
CityStateZip CodeCounty
LecantoFL34461Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600582 03$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME68580Pediatrics - Minor Surgery49533

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
10/2/20037/8/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Flu symptoms
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :130.3
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly manage patient
Principal Injury Giving Rise To The Claim
Myocarditis
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/6/20052005-CA-3806
County Suit Filed inDate of Final Disposition
Citrus6/12/2008
Other Defendants Involved in this Claim
Fredrick, MD, Bryan D
Citrus Memorial Hospital
Nature Coast Pediatrics
Citrus Emergency Services
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
2/26/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$350,000
Loss Adjust Expense Paid to Defense Counsel$58,762
All Other Loss Adjustment Expense Paid$25,402
Injured Person's Total Non-Economic Loss$350,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:8/12/2008 1:48:50 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 06/12/08
 
Field ChangedFormer ValueNew Value
Date of Final Disposition07-FEB-0812-JUN-08

 

 

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Dr. Alex T Villacastin Medical Malpractice Lawsuits - Court Case # 2010-CA-6043

Indemnity Paid: $325,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264682
Claim Number :32243
Date Submitted :8/29/2012
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAlexTVillacastin
Insurer TypeStreet Address of Practice
LicensedPO Box 640573
CityStateZip CodeCounty
Beverly HillsFL34464Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1616023 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME71085Internal Medicine - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Nursing Home 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
7/31/200811/4/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Pneumonia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat pneumonia
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
12/21/20102010-CA-6043
County Suit Filed inDate of Final Disposition
Citrus8/28/2012
Other Defendants Involved in this Claim
Suncoast Primary Care Specialists
Villacastin, ARNP, Alexander T
Life Care Center of Citrus County
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/28/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$325,000
Loss Adjust Expense Paid to Defense Counsel$59,136
All Other Loss Adjustment Expense Paid$12,066
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$0$0
Other Expenses$0$150,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Harold C Ward Medical Malpractice Lawsuits - Court Case # 2005-CA-320

Indemnity Paid: $300,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200536945
Claim Number :20771
Date Submitted :10/1/2005
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualHaroldCWard
Insurer TypeStreet Address of Practice
Licensed8490 W Homosassa Trail
CityStateZip CodeCounty
HomosassaFL34448Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600612 02$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS4812Ophthalmology - Minor Surgery5575

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
1/27/20036/22/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Cataracts
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Cataract surgery
Diagnostic Code :366.8
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to discontinue Plavix prior to surgery
Principal Injury Giving Rise To The Claim
Coronary vessel occlusion
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/9/20052005-CA-320
County Suit Filed inDate of Final Disposition
Citrus8/29/2005
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/29/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$300,000
Loss Adjust Expense Paid to Defense Counsel$17,224
All Other Loss Adjustment Expense Paid$4,076
Injured Person's Total Non-Economic Loss$200,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk Management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Thomas K Ceballos Medical Malpractice Lawsuits - Court Case # 2015 CA 000706 A

Indemnity Paid: $300,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201884031
Claim Number : 1024705-01
Date Submitted : 8/22/2018
 
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 Lynn Louthan
Street Address
5814 Reed Road
City State Zip
Ft Wayne IN 46835
Phone Ext Fax E-Mail Address
(260) 486 - 0778     reportaclaim@medpro.com
 
Insured Information
 
Type First Name MI Last Name
Individual Thomas K Ceballos
Insurer Type Street Address of Practice
Licensed 100 Mercy Way
City State Zip Code County
Joplin MO 64804 Out of state
Policy Number Per Claim Policy Limits Aggregate Policy Limits
727230 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME92981 Radiology - Diagnostic - Minor Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First Name MI Last Name Date of Birth
       
Street Address Gender County where Injury Occurred
  M Citrus
City State Zip Code
     
Location where injury occured Other location where injury occured
Emergency Room  
Name of Institution Code
CITRUS MEMORIAL HOSPITAL 100023
Location of Institutional Injury Other Location of Institutional Injury
Radiology, Emergency Room  
Date of Occurrence Date Reported to Insurer
10/14/2011 3/11/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Pulmonary embolus, shortness of breath
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Interpreted chest x-ray and chest CT scan
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to detect and report a potential mass in upper lobe of right lung
Principal Injury Giving Rise To The Claim
Lung cancer, death
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
8/14/2015 2015 CA 000706 A
County Suit Filed in Date of Final Disposition
Citrus 1/2/2018
Other Defendants Involved in this Claim
Citrus Memorial Health Foundation Inc dba Citrus Mem Hospita
Shah MD, Vikram
Monojkumar B Shukla MD PA dba Citrus Pulmonary Consultants &
Associated Radiologists of Inverness PA
Foundation Resolution Corporation Inc
HCA West Florida
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
12/27/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $300,000
Loss Adjust Expense Paid to Defense Counsel $28,940
All Other Loss Adjustment Expense Paid $21,022
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
n/a
 
Updates
 
 
Date of Change: 8/22/2018 2:05:20 PM
Reason for Change: ALE UPDATE
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 16209 28940
All Other Loss Adjustment Expense Paid 13736 21022

 

 

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Dr. Oliver K Sevilla Medical Malpractice Lawsuits - Court Case # 2008-CA-1457

Indemnity Paid: $292,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263510
Claim Number :26509
Date Submitted :6/22/2012
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualOliverKSevilla
Insurer TypeStreet Address of Practice
Licensed5616 w. Norrell Bryant Highway
CityStateZip CodeCounty
Crystal RiverFL34429Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600609 05$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME93238Pulmonary Diseases - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SEVEN RIVERS COMMUNITY HOSPITAL100249
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
4/20/200611/12/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Pneumonia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat pneumonia
Principal Injury Giving Rise To The Claim
Respiratory failure
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/11/20082008-CA-1457
County Suit Filed inDate of Final Disposition
Citrus5/30/2012
Other Defendants Involved in this Claim
Shukla, MD, Manojkumar B
Citrus Pulmonary Consultants
Seven Rivers Regional Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/14/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$292,500
Loss Adjust Expense Paid to Defense Counsel$29,867
All Other Loss Adjustment Expense Paid$26,970
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$240,000$0
Wage Loss$0$0
Other Expenses$0$700,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:6/22/2012 4:36:09 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 05/30/12
 
Field ChangedFormer ValueNew Value
Date of Final Disposition14-MAR-1230-MAY-12

 

 

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Dr. Constantine A Toumbis Medical Malpractice Lawsuits - Court Case # 2010-CA-763

Indemnity Paid: $281,250.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201160828
Claim Number :30804-30805
Date Submitted :7/5/2011
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualConstantineAToumbis
Insurer TypeStreet Address of Practice
LicensedPO Box 1990
CityStateZip CodeCounty
Crystal RiverFL34423Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1616017 00$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME80012Surgery - Orthopedic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Outpatient Facility 
Name of InstitutionCode
SEVEN RIVERS COMMUNITY HOSPITAL100249
Location of Institutional InjuryOther Location of Institutional Injury
Special Procedure Room 
Date of OccurrenceDate Reported to Insurer
2/14/20086/18/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Post-op wound infection
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Prescribed antibiotics
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged improper selection of post-op antibiotics and failure to discontinue Gentamicin
Principal Injury Giving Rise To The Claim
Bilateral vestibulopathy, toxic labyrinthitis, and hypoactive labyrinths.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/5/20102010-CA-763
County Suit Filed inDate of Final Disposition
Citrus6/21/2011
Other Defendants Involved in this Claim
Citrus Orthopaedic & Joint Institute
Amedisys Home Health of Florida
Seven Rivers Regional Medical Center
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/2/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$281,250
Loss Adjust Expense Paid to Defense Counsel$28,999
All Other Loss Adjustment Expense Paid$9,515
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$6,618$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:7/5/2011 10:17:47 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 06/21/11
 
Field ChangedFormer ValueNew Value
Date of Final Disposition02-JUN-1121-JUN-11

 

 

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Dr. Abel Garibaldi Medical Malpractice Lawsuits - Court Case # 2007 CA 1946

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200953764
Claim Number :HM099213
Date Submitted :5/22/2009
 
Insurer Information
 
Insurer NameCoverage Type
COLUMBIA CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
47-0490411 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualDeniseNEscribano
Street Address
7886 Woodland Center Blvd
CityStateZip
TampaFL33614
PhoneExtFaxE-Mail Address
(813) 880 - 5137 (312) 894 - 3680denise.escribano@cna.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAbel Garibaldi
Insurer TypeStreet Address of Practice
Licensed580 St. Johnsbuy Rd. Suite D
CityStateZip CodeCounty
LittletonNH03561Out of state
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0283540813$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME92303Family Physicians or General Practitioners - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
8/28/20051/5/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Empema & Pulmonary Artery Aneurysm
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to treat pulmonary artery aneurysm. (patient was deemed not to be a surgical candidate)
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
There was no Misdiagnosis made.
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/25/20072007 CA 1946
County Suit Filed inDate of Final Disposition
Citrus5/1/2009
Other Defendants Involved in this Claim
Javier, Luis
Citrus Memorial Hospital
Fernandez, Mark
Campbell, Steven
Crouch, Fred
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
5/6/2009
 
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$18,709
All Other Loss Adjustment Expense Paid$52,514
Injured Person's Total Non-Economic Loss$250,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$43,314$0
Wage Loss$0$260,967
Other Expenses$1,000$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insured discussed case with defense counsel and insurance personnel.
 
Updates
 
No updates found.

 

 

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Dr. Alex A Tambrini Medical Malpractice Lawsuits - Court Case # 2008 CA 5706

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200953927
Claim Number :MM249192
Date Submitted :6/15/2009
 
Insurer Information
 
Insurer NameCoverage Type
EVANSTON INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
36-2950161 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCherry ERadin
Street Address
Ten Parkway North
CityStateZip
DeerfieldIL60015
PhoneExtFaxE-Mail Address
(847) 572 - 6085 (847) 572 - 6338radin@markelcorp.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAlexATambrini
Insurer TypeStreet Address of Practice
Licensed7991 S. Suncoast Blvd.
CityStateZip CodeCounty
HomosassaFL34446Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MM814584$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME98069Internal Medicine - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SEVEN RIVERS COMMUNITY HOSPITAL100249
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
11/11/20075/22/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient presented tothe insured doctor with complaints of neck pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The insured doctor's plan was to work up the patient for possible CHF based on CXR at teh emergency room and included a BNP, echocardiogram and EKG as well as to work up the patient for sevcere neck pain with bilateral upper extremity radiculopathy including an MRI pf the cervical spine. Hospitalization was offerred by the insured docotr tothe patient and his family in order to work up a possible cardiac origin for his complaints as well as to initiate pain management for the severe neck pain. The patient and family declined the insured doctor's recommendation for hospitalization. The patient returned to have a BNP done on the following day which turned out to be normal.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
before further workup could be completed the patient returned to the emergency room due to cardiac arrest and was pronounced DOA.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
5/13/20082008 CA 5706
County Suit Filed inDate of Final Disposition
Citrus5/27/2009
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
5/27/2009
 
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$12,191
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$0
Deductible$5,000
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
None
 
Updates
 
No updates found.

 

 

*NR:Prior to 04/28/1999 this field was not required in submitted claims.

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Dr. Dennis R Daake Medical Malpractice Lawsuits - Court Case # 2005 CA 2496

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200537239
Claim Number :40-010905
Date Submitted :10/12/2005
 
Insurer Information
 
Insurer NameCoverage Type
TRUCK INSURANCE EXCHANGEPrimary
Insurer FEINProfessional License Number
95-2575892 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualHeidi Tam
Street Address
4680 Wilshire Blvd., Sixth Floor
CityStateZip
Los AngelesCA90010
PhoneExtFaxE-Mail Address
(323) 930 - 7078  heidi.tam@farmersinsurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDennisRDaake
Insurer TypeStreet Address of Practice
Licensed6177 Sun Blvd., Apt # 105
CityStateZip CodeCounty
St. PetersburgFL33715Pinellas
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0117776130000$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME15777Emergency Medicine - Including Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SEVEN RIVERS COMMUNITY HOSPITAL100249
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
11/11/20023/12/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient's chest x ray and CT scan were linked more to a pulmonary contusion than pneumonia resulting in improper treatment of pneumonia which led to aspiration pneumonia.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to admit the patient to the hospital and properly treat pneumonia, resulting in the death of the patient several months later.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Diagnosed as pulmonary contusion rather than pneumonia.
Principal Injury Giving Rise To The Claim
Untreated pneumonia progressed to aspiration pneumonia that led to patient's death.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
6/17/20052005 CA 2496
County Suit Filed inDate of Final Disposition
Citrus9/19/2005
Other Defendants Involved in this Claim
Shukla, Manojkumar B
Seven Rivers Community Hospital
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/11/2005
 
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$6,229
All Other Loss Adjustment Expense Paid$7,211
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$9,800$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
This is a risk management issue.There are no risk managment services available to the insured.
 
Updates
 
No updates found.

 

 

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Dr. Thomas R Antony Medical Malpractice Lawsuits - Court Case # 2006CA1477

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200746445
Claim Number :33418-01
Date Submitted :8/3/2007
 
Insurer Information
 
Insurer NameCoverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INCPrimary
Insurer FEINProfessional License Number
59-6614702 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualOdessa Choice
Street Address
1000 Riverside Avenue, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423045(904) 358 - 6728odessa.choice@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualThomasRAntony
Insurer TypeStreet Address of Practice
Licensed800 Medical Center East
CityStateZip CodeCounty
InvernessFL34452Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
60074$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME86004Surgery - Obstetrics - Gynecology80153

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FCitrus
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
CITRUS MEMORIAL HOSPITAL100023
Location of Institutional InjuryOther Location of Institutional Injury
Labor and Delivery Room 
Date of OccurrenceDate Reported to Insurer
7/2/200411/23/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Term pregnancy complicated by gestational diabetes.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Forcep assisted vaginal delivery of female neonate, complicated by shoulder dystocia.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Erb's palsy secondary to shoulder dystocia in NB female requiring reconstructive surgery.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs.Includes non-disabling injuries.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/7/20062006CA1477
County Suit Filed inDate of Final Disposition
Citrus7/18/2007
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/18/2007
 
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$9,895
All Other Loss Adjustment Expense Paid$10,646
Injured Person's Total Non-Economic Loss$250,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$130,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Rose M Sobel Medical Malpractice Lawsuits - Court Case # 2016CA000776A

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782719
Claim Number : 340150
Date Submitted : 8/3/2017
 
Insurer Information
 
Insurer Name Coverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) Primary
Insurer FEIN Professional License Number
95-3014772  
Insurer Contact Information
Type First Name MI Last Name
Individual Kelly   Andrews
Street Address
12724 Gran Bay Parkway, W., Suite 400
City State Zip
Jacksonville FL 32258
Phone Ext Fax E-Mail Address
(904) 360 - 3038     kandrews@thedoctors.com
 
Insured Information
 
Type First Name MI Last Name
Individual Rose M Sobel
Insurer Type Street Address of Practice
Licensed 6151 N. Suncoast Blvd. Suite 1-C
City State Zip Code County
Crystal River FL 34428 Citrus
Policy Number Per Claim Policy Limits Aggregate Policy Limits
0072101 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME81874 Surgery - Obstetrics - Gynecology  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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
Hospital Inpatient Facility  
Name of Institution Code
SEVEN RIVERS COMMUNITY HOSPITAL 100249
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
1/29/2016 3/10/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Rectocele and enterocele.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Post operative administration of Dilaudid.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Death.
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
9/9/2016 2016CA000776A
County Suit Filed in Date of Final Disposition
Citrus 7/20/2017
Other Defendants Involved in this Claim
Crystal River Women's Health Center, PA
Easter, Alicia M
Beemer, Tamara L
Seven River Regional Medical Center
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
7/20/2017
 
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 $36,795
All Other Loss Adjustment Expense Paid $9,728
Injured Person's Total Non-Economic Loss $250,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $368,000 $0
Wage Loss $120,000 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Todd Bergan Medical Malpractice Lawsuits - Court Case # 2016 CA 000018 A

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
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  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

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
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
No updates found.

 

 

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Dr. MARY L KOLAR Medical Malpractice Lawsuits - Court Case # 2016 CA 000018 A

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201679803
Claim Number : 0917509248US
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 MARY L KOLAR
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 $250,000 $750,000
Profession or Business Other Profession or Business
Osteopathic Physician  
License Number Specialty Code & Classification Certification Number
OS4815 Emergency Medicine - Including Major Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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 7/25/2016
 
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
pltf returned to ER with complaints of body aches, dark urine & dark stool. Insd PA Bergan gave pain meds for back pain, noted ER visit prior day & discharged her without repeat INR. Insd Dr. Kolar signed off on discharge.
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.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

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
9/28/2016
 
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 $0
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
No updates found.

 

 

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Dr. John Arnold Medical Malpractice Lawsuits - Court Case # 2016 CA 000018 A

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201679805
Claim Number : 2876229473US
Date Submitted : 9/29/2016
 
Insurer Information
 
Insurer Name Coverage Type
LEXINGTON INSURANCE COMPANY Excess
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 John   Arnold
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 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME90636 Emergency Medicine - No Major Surgery  

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
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 7/25/2016
 
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
The lab result showed an INR greater than 10 so Dr. Arnold ordered a vitamin K shot. Patient was then discharged without rechecking the INR.
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.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

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
9/28/2016
 
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 $0
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
No updates found.

 

 

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