Medical Malpractice Cases

Medical Malpractice Cases In Hernando County Florida

Dr. George S Sidhom Medical Malpractice Lawsuits - Court Case # CA09-465

Indemnity Paid: $1,537,227.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201160146
Claim Number :28230/36353
Date Submitted :3/17/2011
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualCathy Tschanz
Street Address
8427 South Park Circle, Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813  ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualGeorgeSSidhom
Insurer TypeStreet Address of Practice
Licensed5193 Mariner Blvd.
CityStateZip CodeCounty
Spring HillFL34609Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600118 08$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME66412Physical Medicine and Rehabilitation - Pain Management 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Patient's Home 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
8/11/20069/15/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Back pain; lumbar spine failed surgery
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Prescription of pain medications
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly manage pain medications
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
2/13/2009CA09-465
County Suit Filed inDate of Final Disposition
Hernando3/9/2011
Other Defendants Involved in this Claim
Hernando Pain Management Center
Brandon Pain Clinic
George S. Sidhom M.D., P.A.
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
Judgment for the plaintiff. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/9/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$1,537,227
Loss Adjust Expense Paid to Defense Counsel$184,720
All Other Loss Adjustment Expense Paid$77,152
Injured Person's Total Non-Economic Loss$1,000,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$537,227
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:3/17/2011 2:34:31 PM
Reason for Change:Report updated to correct the Indemnity Paid amount.
 
Field ChangedFormer ValueNew Value
Indemnity Paid1537227371537227

 

 

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Dr. Pariksith Singh Medical Malpractice Lawsuits - Court Case # 17-000614-CA

Indemnity Paid: $1,000,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201886721
Claim Number : 60937
Date Submitted : 10/12/2018
 
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 Pariksith   Singh
Insurer Type Street Address of Practice
Licensed 14690 Spring Hill Dr., Ste. 101
City State Zip Code County
Spring Hill FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1600367 17 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME71088 Internal Medicine - No 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
2/18/2015 2/6/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
MSSA
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 follow-up on positive blood culture results
Principal Injury Giving Rise To The Claim
MSSA
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
6/2/2017 17-000614-CA
County Suit Filed in Date of Final Disposition
Hernando 9/20/2018
Other Defendants Involved in this Claim
Vennamaneni, MD, Manjusri
Weiss, MD, Henry J
Ganti, MD, Krishna
Oak Hill Hospital
Markova-Acevedo, MD, Yuliya
Almisegger, ARNP, James
Kersey, PAC, Brian
Baig, ARNP, Sarah
Access Healthcare
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
9/20/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $1,000,000
Loss Adjust Expense Paid to Defense Counsel $7,561
All Other Loss Adjustment Expense Paid $0
Injured Person's Total Non-Economic Loss $0
Deductible $36,918
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $1,094,823 $150,000
Wage Loss $0 $0
Other Expenses $0 $200,000
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. Lingappa Amarchand Medical Malpractice Lawsuits - Court Case # CA2013-311

Indemnity Paid: $956,250.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201677030
Claim Number : 42850
Date Submitted : 2/5/2016
 
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 Lingappa   Amarchand
Insurer Type Street Address of Practice
Licensed 14690 Spring Hill Drive, Suite 101
City State Zip Code County
Spring Hill FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1600367 13 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME64872 Cardiovascular Disease - 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
  F Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
4/28/2012 6/27/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Fluid overload
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 manage and adjust IV fluids
Principal Injury Giving Rise To The Claim
Heart failure
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
11/25/2012 CA2013-311
County Suit Filed in Date of Final Disposition
Hernando 12/30/2015
Other Defendants Involved in this Claim
Juvvadi, MD, Raghu
Spring Hill Regional Hospital
Access Health Care
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 Decision Other
Other Plaintiff verdict - high/low
Arbitration
Claim not subject to Arbitration.
Date of Payment
1/13/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $956,250
Loss Adjust Expense Paid to Defense Counsel $146,662
All Other Loss Adjustment Expense Paid $80,800
Injured Person's Total Non-Economic Loss $795,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $40,000 $0
Wage Loss $0 $0
Other Expenses $7,000 $645,000
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. RONDA DEDRICK Medical Malpractice Lawsuits - Court Case # CA 10-2509

Indemnity Paid: $875,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201369188
Claim Number :EMC-09-XS-115099
Date Submitted :12/13/2013
 
Insurer Information
 
Insurer NameCoverage Type
EmCare Holdings, Inc.Primary
Insurer FEINProfessional License Number
75-173235SI
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKathyAStockton
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 2404 (713) 461 - 8130kathy_stockton@westernlitigation.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRONDA DEDRICK
Insurer TypeStreet Address of Practice
Self-Insurer13075 KINGSBORO ROAD
CityStateZip CodeCounty
WEEKI WACHEEFL34614Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
EMC-2009-Excess$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
OtherNURSE PRACTITIONER
License NumberSpecialty Code & ClassificationCertification Number
ARNP2890652  

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
BROOKSVILLE REGIONAL HOSPITAL 100071
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
4/13/20093/30/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Flr to timely dx and tx cervical spine compression r/i neurological deficit
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Flr to timely dx and tx cervical spine compression r/i neurological deficit
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Flr to timely dx and tx cervical spine compression r/i neurological deficit
Principal Injury Giving Rise To The Claim
Flr to timely dx and tx cervical spine compression r/i neurological deficit
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/28/2010CA 10-2509
County Suit Filed inDate of Final Disposition
Hernando11/13/2013
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 subject to arbitration, but settlement reached in lieu of award.
Date of Payment
9/12/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$875,000
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. Paul Rohart Medical Malpractice Lawsuits - Court Case # CA-08-1249

Indemnity Paid: $850,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955628
Claim Number :SGI-06-75034
Date Submitted :12/1/2009
 
Insurer Information
 
Insurer NameCoverage Type
The Schumacher GroupPrimary
Insurer FEINProfessional License Number
72-1383025 
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
IndividualPaul Rohart
Insurer TypeStreet Address of Practice
Self-Insurer109 Carlyle Circle
CityStateZip CodeCounty
Palm HarborFL34683Palm Beach
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMI AE 0801 046$1,000,000$1,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME59841Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
BROOKSVILLE REGIONAL HOSPITAL 100071
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
1/26/200712/17/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented to E.D. with history of low back pain, increasingly painful with walking.Denied trauma.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to diagnose cauda equina
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose
Principal Injury Giving Rise To The Claim
ower extremity numbness and some paralysis along with bladder and bowel dysfunction
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
5/6/2008CA-08-1249
County Suit Filed inDate of Final Disposition
Hernando11/30/2009
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 subject to arbitration, but settlement reached in lieu of award.
Date of Payment
11/13/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$850,000
Loss Adjust Expense Paid to Defense Counsel$103,743
All Other Loss Adjustment Expense Paid$15,755
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
Subject of this report stated that patient had no signs or symptoms of cauda equina during ED visit.
 
Updates
 
No updates found.

 

 

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Dr. MAYLIN LOPEZ CORTES Medical Malpractice Lawsuits - Court Case # 26868801

Indemnity Paid: $750,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201781024
Claim Number : EMC-AO-14XS-331717
Date Submitted : 2/1/2017
 
Insurer Information
 
Insurer Name Coverage Type
EmCare Holdings, Inc. Primary
Insurer FEIN Professional License Number
75-173235 SI
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 MAYLIN   LOPEZ CORTES
Insurer Type Street Address of Practice
Self-Insurer 10461 QUALITY DRIVE
City State Zip Code County
SPRING HILL FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
Emcare 2014-Excess $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME117226 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Emergency Room  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Other ER
Date of Occurrence Date Reported to Insurer
7/26/2014 12/19/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
STROKE
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 AND TREAT
Principal Injury Giving Rise To The Claim
STROKE
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
5/4/2015 26868801
County Suit Filed in Date of Final Disposition
Hernando 2/1/2017
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
1/12/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $750,000
Loss Adjust Expense Paid to Defense Counsel $56,660
All Other Loss Adjustment Expense Paid $29,165
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. Sanford R Dolgin Medical Malpractice Lawsuits - Court Case # H27-CA-2002001725-DM

Indemnity Paid: $650,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200743902
Claim Number :A02-25618-00
Date Submitted :1/11/2007
 
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
IndividualSanfordRDolgin
Insurer TypeStreet Address of Practice
Licensed4714 North Armenia Ave, Ste 200
CityStateZip CodeCounty
TampaFL33603Hillsborough
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
9795$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME60810Surgery - Otorhinolaryngology80159

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FPasco
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
7/2/20002/20/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Facial trauma from horse kick with comminuted facial fracture and facial laceration with loose and expelled teeth.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Laceration repairs and open reduction and fracture stabilization with internal titanium plates and septoplasty.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Plaintiff alleges that a palate fracture was not diagnosed or treated timely.
Principal Injury Giving Rise To The Claim
Crossbite and residual pain and loss of jaw function.
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
7/18/2002H27-CA-2002001725-DM
County Suit Filed inDate of Final Disposition
Hernando12/20/2006
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
After appeal.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
Judgment for the plaintiff after appeal ... 
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/20/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$650,000
Loss Adjust Expense Paid to Defense Counsel$187,259
All Other Loss Adjustment Expense Paid$163,852
Injured Person's Total Non-Economic Loss$650,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$155,231$7,200
Wage Loss$148,000$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. Risk management referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. THOMAS ARMBRUSTER Medical Malpractice Lawsuits - Court Case # CA 08-2704

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201058350
Claim Number :2-08-0008A
Date Submitted :8/23/2010
 
Insurer Information
 
Insurer NameCoverage Type
FLORIDA HEALTHCARE PROVIDERS INSURANCE EXCHANGEPrimary
Insurer FEINProfessional License Number
20-0143902 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualLinda Collins
Street Address
4655 Salisbury Road, Ste. 110
CityStateZip
JacksonvilleFL32256
PhoneExtFaxE-Mail Address
(904) 296 - 2887214(904) 394 - 7134lcollins@fldic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualTHOMAS ARMBRUSTER
Insurer TypeStreet Address of Practice
Licensed13908 Lakeshore Blvd., Ste. 250
CityStateZip CodeCounty
HudsonFL34667Pasco
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CM01000189$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME58500Surgery - Obstetrics - Gynecology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MPasco
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Labor and Delivery Room 
Date of OccurrenceDate Reported to Insurer
10/29/20062/15/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Birth.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No procedure performed.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis made.
Principal Injury Giving Rise To The Claim
Alleged brachial plexus injury resulting during vaginal delivery.
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
7/1/2007CA 08-2704
County Suit Filed inDate of Final Disposition
Hernando8/23/2010
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
7/7/2010
 
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$159,474
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
Circumstances of this case have been discussed with the Insured and Risk Management was notified.Risk Management has discussed this case with the Insured.
 
Updates
 
No updates found.

 

 

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Dr. Ravishankar Rao Medical Malpractice Lawsuits - Court Case # 2015-CA-0834

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782683
Claim Number : 52519
Date Submitted : 8/15/2017
 
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 Ravishankar   Rao
Insurer Type Street Address of Practice
Licensed 15435 Cortez Blvd.
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1600565 13 $500,000 $150,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME63596 Internal Medicine - No 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
2/22/2013 3/3/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Bowel obstruction
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 order surgical consult and treat bowel obstruction and ischemia
Principal Injury Giving Rise To The Claim
Cardiorespiratory arrest
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
7/8/2015 2015-CA-0834
County Suit Filed in Date of Final Disposition
Hernando 8/10/2017
Other Defendants Involved in this Claim
Kuruscz, III, MD, Henry
Spring Hill 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 Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/13/2017
 
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 $57,799
All Other Loss Adjustment Expense Paid $10,561
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $100,000 $0
Wage Loss $0 $0
Other Expenses $0 $1,500,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change: 8/15/2017 11:24:52 AM
Reason for Change: Report updated to reflect Court Document final disposition date of 08/10/17
 
Field Changed Former Value New Value
Date of Final Disposition 13-JUL-17 10-AUG-17

 

 

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Dr. Niloufer Kero Medical Malpractice Lawsuits - Court Case # 97-1383 CA01

Indemnity Paid: $497,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200848457
Claim Number :E24511-01
Date Submitted :8/20/2009
 
Insurer Information
 
Insurer NameCoverage Type
PROASSURANCE CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
38-2317569 
Insurer Contact Information
TypeEntity Name
EntityProAssurance Indemnity Company, Inc.
Street Address
13919 Carrollwood Village Run
CityStateZip
TampaFL33618-2746
PhoneExtFaxE-Mail Address
(813) 969 - 2010 (813) 969 - 2120SNorris@ProAssurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualNiloufer Kero
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd., Suite 401
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PNFL-1004364-00$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME43867Surgery - Obstetrics - Gynecology00000

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Labor and Delivery Room 
Date of OccurrenceDate Reported to Insurer
10/19/19944/19/1996
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Term pregnancy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Termination of pregnancy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis.
Principal Injury Giving Rise To The Claim
Neurogenic bladder.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/18/199797-1383 CA01
County Suit Filed inDate of Final Disposition
Hernando1/29/2008
Other Defendants Involved in this Claim
Sztulman, Luciano
Niloufer Kero, M.D., d/b/a Suncoast Obstetrics and Gynecolog
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
1/30/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$497,500
Loss Adjust Expense Paid to Defense Counsel$130,164
All Other Loss Adjustment Expense Paid$62,598
Injured Person's Total Non-Economic Loss$497,500
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
Insured has discussed case with insurance company personnel, medical experts and defense counsel.
 
Updates
 
 
Date of Change:8/20/2009 12:02:18 PM
Reason for Change:Report updated to reflect additional legal fees and expenses paid.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel128715130164
All Other Loss Adjustment Expense Paid6192762598

 

 

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Dr. Michael K Herron Medical Malpractice Lawsuits - Court Case # 2016CA1419

Indemnity Paid: $490,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201884336
Claim Number : 342608
Date Submitted : 2/14/2018
 
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 Michael K Herron
Insurer Type Street Address of Practice
Licensed 8303 South Suncoast Blvd.
City State Zip Code County
Homosassa FL 34446 Citrus
Policy Number Per Claim Policy Limits Aggregate Policy Limits
0751285 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME84779 Radiology - Diagnostic - No 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 Pasco
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Location Spring Hill MRI
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Other RADIOLOGY
Date of Occurrence Date Reported to Insurer
9/15/2014 5/12/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented with pain in his lower back radiating down to his leg.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
A lumbar MRI was interpreted by the insured.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to identify the beginning process of an infection resulting in osteomyelitis.
Principal Injury Giving Rise To The Claim
Unable to walk long distances without a cane.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
1/16/2017 2016CA1419
County Suit Filed in Date of Final Disposition
Hernando 1/30/2018
Other Defendants Involved in this Claim
Spring Hill MRI
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
1/30/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $490,000
Loss Adjust Expense Paid to Defense Counsel $46,537
All Other Loss Adjustment Expense Paid $15,719
Injured Person's Total Non-Economic Loss $490,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $92,500 $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. Patient Safety referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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Dr. Manjusri Vennamaneni Medical Malpractice Lawsuits - Court Case # 17-000614-CA

Indemnity Paid: $401,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201886718
Claim Number : 60881
Date Submitted : 10/12/2018
 
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 Manjusri   Vennamaneni
Insurer Type Street Address of Practice
Licensed 14690 Spring Hill Dr. Ste. 101
City State Zip Code County
Spring Hill FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1600367 17 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME93756 Internal Medicine - No 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
2/18/2015 2/6/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
MSSA
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 follow-up on positive blood culture results
Principal Injury Giving Rise To The Claim
MSSA
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
6/2/2017 17-000614-CA
County Suit Filed in Date of Final Disposition
Hernando 9/20/2018
Other Defendants Involved in this Claim
Weiss, MD, Henry J
Singh, MD, Pariksith
Ganti, MD, Krishna
Oak Hill Hospital
Markova-Acevedo, MD, Yuliya
Almisegger, ARNP, James
Kersey, PAC, Brian
Baig, ARNP, Sarah
Access Healthcare
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
9/20/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $401,000
Loss Adjust Expense Paid to Defense Counsel $71,500
All Other Loss Adjustment Expense Paid $8,357
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $1,094,823 $150,000
Wage Loss $0 $0
Other Expenses $0 $200,000
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. Mark A Barnhurst Medical Malpractice Lawsuits - Court Case # 2012-CA-002072

Indemnity Paid: $400,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201680646
Claim Number : 40372/40520
Date Submitted : 12/16/2016
 
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 Mark A Barnhurst
Insurer Type Street Address of Practice
Licensed 14690 Spring Hill Dr. Ste. 101
City State Zip Code County
Spring Hill FL 34609 Citrus
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1602528 03 $250,000 $750,000
Profession or Business Other Profession or Business
Physician Assistant  
License Number Specialty Code & Classification Certification Number
PA9101148 Additional Charges: Employed Physicians or Surgeons Assistants  

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 Access Health Care Walk-In Clinic
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
2/24/2010 2/21/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
TIAs
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 TIAs
Principal Injury Giving Rise To The Claim
Stroke
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
7/6/2012 2012-CA-002072
County Suit Filed in Date of Final Disposition
Hernando 12/1/2016
Other Defendants Involved in this Claim
Access Health Care
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
12/1/2016
 
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 $113,623
All Other Loss Adjustment Expense Paid $40,312
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $56,000 $0
Wage Loss $0 $0
Other Expenses $5,100 $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. Adrian I Medina Medical Malpractice Lawsuits - Court Case # H27CA20040003210

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200538248
Claim Number :40-009531
Date Submitted :11/11/2005
 
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
IndividualAdrianIMedina
Insurer TypeStreet Address of Practice
Licensed1328 HOMESTEAD RD N
CityStateZip CodeCounty
LEHIGH ACRESFL33936-6024Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0118060060000$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME74141Surgery - Orthopedic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other LocationPhysician's Office
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
9/12/200111/11/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Radial Head Fracture.The patient has a bowing deformity of the ulna that is bowed towards the radius.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Insured doctor undertook his care on September 12, 2001.He diagnosed him as sustaining a type-A Monteggia fracture of the right ulnar with a non-displaced fracture of the shaft and a radial ulnar subluxation of the radial head and partial radial nerve palsy.He had a closed reduction manipulation of the elbow and placed in a long arm cast.Insured doctor and his physician's assistant continued with the follow up care of the patient at least through November 16, 2001.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Plaintiff alleges that the insured failed to see the radial head dislocation evident on all x-rays after he performed the closed reduction, failed to recognize the progressive ulnar angulation and allowed the bone to heal in a deformed position, resulting in Bowing deformity of the ulna that is bowed towards the radius.
Principal Injury Giving Rise To The Claim
Bowing deformity of the ulna that is bowed towards the radius.
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
4/13/2004H27CA20040003210
County Suit Filed inDate of Final Disposition
Hernando10/21/2005
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
10/25/2005
 
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$8,351
All Other Loss Adjustment Expense Paid$9,301
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$5,000$75,000
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insured doctor diagnosed the patient with a type A-Monteggia fracture of the right ulnar with a non-displaced fracture of the shaft and a radial ulnar subluxation of the radial and partial radial nerve palsy.Insured relied on his physician's assistant for all of the follow up appointments and did not review the x-rays himself which revealed that the dislocation was getting worse.Insured is currenly not practicing.
 
Updates
 
No updates found.

 

 

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Dr. Bradley S Stellpflug Medical Malpractice Lawsuits - Court Case # H27CA-2007-1256

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200953636
Claim Number :SGI-06-67244
Date Submitted :5/11/2009
 
Insurer Information
 
Insurer NameCoverage Type
CITADEL INSURANCE, RISK RETENTION GROUPPrimary
Insurer FEINProfessional License Number
20-8474742 
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
IndividualBradleySStellpflug
Insurer TypeStreet Address of Practice
Licensed4381 Hunters Pass
CityStateZip CodeCounty
Spring HillFL34609Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMI AE 0801 046$1,000,000$24,000,000
Profession or BusinessOther Profession or Business
Osteopathic Physician 
License NumberSpecialty Code & ClassificationCertification Number
OS8784Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
10/23/20052/14/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Perianal abscess
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to admit, obtain consult
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Diagnosed with cyst as opposed to abscess
Principal Injury Giving Rise To The Claim
Prolonged hospitalization, surgeries, colostomy
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
8/2/2007H27CA-2007-1256
County Suit Filed inDate of Final Disposition
Hernando5/10/2009
Other Defendants Involved in this Claim
Hernando Emergency Group, LLC
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
4/2/2009
 
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$61,660
All Other Loss Adjustment Expense Paid$11,243
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. Charmin Kuhn Medical Malpractice Lawsuits - Court Case # CA 09-184

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955212
Claim Number :37613-03
Date Submitted :10/22/2009
 
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
IndividualCharmin Kuhn
Insurer TypeStreet Address of Practice
Licensed10200 Yale Avenue
CityStateZip CodeCounty
Spring HillFL34611Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
59162$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Physician Assistant 
License NumberSpecialty Code & ClassificationCertification Number
PA9101155Physicians or Surgeons Assistants71520

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Patient's Home 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
6/28/20069/5/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented with complaints of shortness of breath, mild chest pain and left neck pain and was diagnosed with hypertension, diabetes and dyslipidemia.Some four months later, he died of an acute MI.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
None.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly monitor, evaluate and treat patient for underlying hypertension, dyslipidemia and neck pain.
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
2/27/2009CA 09-184
County Suit Filed inDate of Final Disposition
Hernando10/1/2009
Other Defendants Involved in this Claim
Denner, D.O., Mark
The Springs Family Medical Center, P.A.
Idicula, M.D., Joseph
Bikkasani, M.D., Naveen
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
10/1/2009
 
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$8,215
All Other Loss Adjustment Expense Paid$2,790
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. Shilen N Patel Medical Malpractice Lawsuits - Court Case # 2015-CA-766

Indemnity Paid: $350,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201678816
Claim Number : 51460/61
Date Submitted : 6/24/2016
 
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 Shilen N Patel
Insurer Type Street Address of Practice
Licensed 7324 Littel Road
City State Zip Code County
New Port Richey FL 34654 Pasco
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1603159 00 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME113239 Oncology - 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
  F Pasco
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
OAK HILL HOSPITAL 100264
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
4/12/2014 11/12/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Thrombotic thrombocytopenic purpura
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 treat TTP
Principal Injury Giving Rise To The Claim
TTP
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
7/20/2015 2015-CA-766
County Suit Filed in Date of Final Disposition
Hernando 6/8/2016
Other Defendants Involved in this Claim
Belicena, MD, Maria
Abbruzzese, MD, Danny
Adler, ARNP, Suzanne
Oak Hill 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 Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/8/2016
 
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 $59,818
All Other Loss Adjustment Expense Paid $7,618
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 $3,065 $500,000
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. BRADLEY STELLPFLUG Medical Malpractice Lawsuits - Court Case # H-27-CA-2006-1047-DM

Indemnity Paid: $325,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200851582
Claim Number :617171
Date Submitted :12/3/2008
 
Insurer Information
 
Insurer NameCoverage Type
APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC.Primary
Insurer FEINProfessional License Number
81-0603029 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualRebeccaVGluff
Street Address
7369 Sheridan Street, Suite 301
CityStateZip
HollywoodFL33024
PhoneExtFaxE-Mail Address
(608) 879 - 2092 (608) 879 - 2746Becky.Gluff@cambridge-na.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualBRADLEY STELLPFLUG
Insurer TypeStreet Address of Practice
Licensed10461 Quality Drive
CityStateZip CodeCounty
Spring HillFL34609Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
115097$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS8784Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
9/10/200410/31/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Sepsis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Kidney Stones - Sepsis
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Kidney Stones
Principal Injury Giving Rise To The Claim
Sepsis
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/18/2006H-27-CA-2006-1047-DM
County Suit Filed inDate of Final Disposition
Hernando7/21/2008
Other Defendants Involved in this Claim
Spring Hill Regional 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
7/29/2008
 
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$23,885
All Other Loss Adjustment Expense Paid$11,735
Injured Person's Total Non-Economic Loss$325,000
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
No safety steps taken.
 
Updates
 
No updates found.

 

 

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Dr. Raghu Juvvadi Medical Malpractice Lawsuits - Court Case # CA2013-311

Indemnity Paid: $318,750.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201677029
Claim Number : 41728
Date Submitted : 2/5/2016
 
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 Raghu   Juvvadi
Insurer Type Street Address of Practice
Licensed 14690 Spring Hill Drive, Suite 101
City State Zip Code County
Spring Hill FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1600367 13 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME101869 Surgery - Nephrology  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
4/27/2012 6/27/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Fluid overload
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 manage and adjust IV fluids
Principal Injury Giving Rise To The Claim
Heart failure
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
11/25/2012 CA2013-311
County Suit Filed in Date of Final Disposition
Hernando 12/30/2015
Other Defendants Involved in this Claim
Amarchand, MD, Lingappa
Spring Hill Regional Hospital
Access Health Care
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 Decision Other
Other Plaintiff verdict - high/low
Arbitration
Claim not subject to Arbitration.
Date of Payment
1/13/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $318,750
Loss Adjust Expense Paid to Defense Counsel $159,948
All Other Loss Adjustment Expense Paid $84,832
Injured Person's Total Non-Economic Loss $265,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $40,000 $0
Wage Loss $0 $0
Other Expenses $7,000 $645,000
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. Shilen N Patel Medical Malpractice Lawsuits - Court Case # CA-15-378

Indemnity Paid: $300,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201885380
Claim Number : 51476
Date Submitted : 5/25/2018
 
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 Shilen N Patel
Insurer Type Street Address of Practice
Licensed 7324 Little Rd.
City State Zip Code County
New Port Richey FL 34654 Pasco
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1603159 00 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME113239 Oncology - 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
BROOKSVILLE REGIONAL HOSPITAL 100071
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
12/26/2012 11/13/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Coagulopathy
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 appropriately workup and treat coagulopathy
Principal Injury Giving Rise To The Claim
PE
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
4/15/2015 CA-15-378
County Suit Filed in Date of Final Disposition
Hernando 4/25/2018
Other Defendants Involved in this Claim
Allen-Khalil, MD, Lisa
Schultz, MD, Jason D
Ocala Oncology Center
Brooksville Regional Medical Center
Emcare, 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
4/25/2018
 
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 $57,010
All Other Loss Adjustment Expense Paid $17,066
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
Risk management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. SISTO P SERAFINI Medical Malpractice Lawsuits - Court Case # 2017-CA-001340

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201886853
Claim Number : 164991
Date Submitted : 10/26/2018
 
Insurer Information
 
Insurer Name Coverage Type
NORCAL MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
94-2301054  
Insurer Contact Information
Type First Name MI Last Name
Individual Jessica   Lance
Street Address
4651 Salisbury Rd Suite 410
City State Zip
Jacksonville FL 32256
Phone Ext Fax E-Mail Address
(904) 309 - 8129     jlance@norcal-group.com
 
Insured Information
 
Type First Name MI Last Name
Individual SISTO P SERAFINI
Insurer Type Street Address of Practice
Licensed Ste 103
City State Zip Code County
Spring Hill FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
721079N $250,000 $750,000
Profession or Business Other Profession or Business
Osteopathic Physician  
License Number Specialty Code & Classification Certification Number
OS11153 Internal Medicine - No 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
   
Date of Occurrence Date Reported to Insurer
4/9/2014 8/10/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
rheumatoid arthritis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
treated with prescription of methotrexate
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
no misdiagnosis made
Principal Injury Giving Rise To The Claim
alleged methotrexate toxicity
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
1/9/2018 2017-CA-001340
County Suit Filed in Date of Final Disposition
Hernando 9/24/2018
Other Defendants Involved in this Claim
JSA Healthcare
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
8/31/2018
 
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 $34,116
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
discussed with insured. will contact risk management if necessary
 
Updates
 
No updates found.

 

 

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Dr. MOHAMED A SHAHOUT Medical Malpractice Lawsuits - Court Case # x2017-CA-412

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201884895
Claim Number : 347464
Date Submitted : 3/29/2018
 
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 MOHAMED A SHAHOUT
Insurer Type Street Address of Practice
Licensed 11375 Cortez Blvd
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
1129158 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME89389 Anesthesiology - All Other  

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 Outpatient Facility  
Name of Institution Code
OAK HILL HOSPITAL 100264
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
4/7/2016 9/20/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Constipation and rectal bleeding.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Anesthesia during colonoscopy for 67 year old female with multiple comorbidities.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
During procedure patient desaturated and suffered an an anoxic brain injury requiring intubation, feeding tube and complete care.
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
4/19/2017 x2017-CA-412
County Suit Filed in Date of Final Disposition
Hernando 3/23/2018
Other Defendants Involved in this Claim
Oak Hill 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 Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/23/2018
 
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 $34,391
All Other Loss Adjustment Expense Paid $3,977
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $210,000 $0
Wage Loss $0 $0
Other Expenses $30,000 $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.

 

 

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

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Dr. John A Manubay Medical Malpractice Lawsuits - Court Case # 2017-CA-398

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201885345
Claim Number : 1038473-01
Date Submitted : 8/28/2018
 
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 John A Manubay
Insurer Type Street Address of Practice
Licensed 11343 Cortez Blvd
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
631160 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME75741 Surgery - General  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
   
Date of Occurrence Date Reported to Insurer
5/23/2014 11/7/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Intermittently painful and enlarging right breast mass with blood tinged nipple discharge
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
excisional biopsy on right breast mass, subcutaneous mastectomy without reconstruction of right breast
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
negligent in the care and treatment of patient
Principal Injury Giving Rise To The Claim
benign pathology, infection, loss of breast tissue, disfiguration, and need for future surgery
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
4/4/2017 2017-CA-398
County Suit Filed in Date of Final Disposition
Hernando 5/14/2018
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 not subject to Arbitration.
Date of Payment
5/7/2018
 
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 $44,477
All Other Loss Adjustment Expense Paid $19,133
Injured Person's Total Non-Economic Loss $110,000
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: 8/28/2018 10:20:03 AM
Reason for Change: ALE UPDATE
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 43077 44477
All Other Loss Adjustment Expense Paid 18296 19133

 

 

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Dr. Guy E Tanner Medical Malpractice Lawsuits - Court Case # 272015CA000030

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201576363
Claim Number : FL0392
Date Submitted : 11/19/2015
 
Insurer Information
 
Insurer Name Coverage Type
HEALTHCARE UNDERWRITERS GROUP, INC. Primary
Insurer FEIN Professional License Number
74-3129288  
Insurer Contact Information
Type First Name MI Last Name
Individual Yvette   de la Morena
Street Address
1250 S. Pine Island Road Suite 300
City State Zip
Plantation FL 33324
Phone Ext Fax E-Mail Address
(954) 923 - 1900     ymorena@hugroups.com
 
Insured Information
 
Type First Name MI Last Name
Individual Guy E Tanner
Insurer Type Street Address of Practice
Licensed 101 SE 2nd Avenue
City State Zip Code County
Crystal River FL 34429 Citrus
Policy Number Per Claim Policy Limits Aggregate Policy Limits
329-000 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME88006 Anesthesiology  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
OAK HILL HOSPITAL 100264
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
9/29/2012 9/15/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Final diagnosis for treatment sough was for an abdominal aortic aneurysm
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Plaintiffs allege negligence during thrombectomy by administering anesthesia too soon after the patient had eaten causing aspiration and subsequent aspiration pneumonia
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis
Principal Injury Giving Rise To The Claim
Plaintiffs allege negligence during thrombectomy by administering anesthesia too soon after the patient had eaten causing aspiration and subsequent aspiration pneumonia
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
1/6/2015 272015CA000030
County Suit Filed in Date of Final Disposition
Hernando 10/19/2015
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
11/19/2015
 
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 $45,770
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
Discussed with insured.
 
Updates
 
No updates found.

 

 

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Dr. Michael Herron Medical Malpractice Lawsuits - Court Case # CA12-1182

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201471604
Claim Number :294919
Date Submitted :8/14/2014
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTiffanyDTaylor
Street Address
13450 West Sunrise Blvd
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(877) 320 - 0748  TTaylor@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMichael Herron
Insurer TypeStreet Address of Practice
Licensed8303 South Suncoast Blvd.
CityStateZip CodeCounty
HomosassaFL34446Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0751285$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME84779Radiology - Diagnostic - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
BROOKSVILLE REGIONAL HOSPITAL 100071
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
10/31/20094/16/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The insured performed a Thorocentesis.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Following a Thorocentesis procedure performed by the insured he issued an order to "Hold Plavix in A.M."
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
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
4/13/2012CA12-1182
County Suit Filed inDate of Final Disposition
Hernando7/31/2014
Other Defendants Involved in this Claim
Beinhauer, M.D., Gerald
Brookville Regional 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
7/21/2014
 
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$74,287
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$250,000
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
Unknown
 
Updates
 
No updates found.

 

 

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

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Dr. James M Esser Medical Malpractice Lawsuits - Court Case # 16-CA-000921

Indemnity Paid: $250,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782260
Claim Number : 1032192
Date Submitted : 2/27/2018
 
Insurer Information
 
Insurer Name Coverage Type
NATIONAL FIRE & MARINE INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
47-6021331  
Insurer Contact Information
Type First Name MI Last Name
Individual Myra Lassen
Street Address
5814 Reed Road
City State Zip
Ft Wayne IN 46835
Phone Ext Fax E-Mail Address
(800) 463 - 3776     reportaclaim@medpro.com
 
Insured Information
 
Type First Name MI Last Name
Individual James M Esser
Insurer Type Street Address of Practice
Licensed 6016 Park Blvd N
City State Zip Code County
Pinellas Park FL 33781 Pinellas
Policy Number Per Claim Policy Limits Aggregate Policy Limits
ES009775 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME57602 Radiology - Diagnostic - No 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Outpatient Facility West Hernando Diagnostic and MR Center
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Radiology, Emergency Room  
Date of Occurrence Date Reported to Insurer
7/31/2014 3/2/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Pain on left side of chest
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
MRI of spine
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failed to diagnose tumor
Principal Injury Giving Rise To The Claim
Delay in treatment
Severity Of Injury
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
7/26/2016 16-CA-000921
County Suit Filed in Date of Final Disposition
Hernando 5/4/2017
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
5/22/2017
 
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 $51,434
All Other Loss Adjustment Expense Paid $0
Injured Person's Total Non-Economic Loss $250,000
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: 9/13/2017 2:28:31 PM
Reason for Change: ALE Updated
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 34031 51309
 
Date of Change: 2/27/2018 9:52:37 AM
Reason for Change: ALE Update
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 51309 51434

 

 

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Dr. Robert Weaver Medical Malpractice Lawsuits - Court Case # H-27-CA-2004-385-DM

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200538552
Claim Number :18802
Date Submitted :12/2/2005
 
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
IndividualRobert Weaver
Insurer TypeStreet Address of Practice
Licensed13 Mastic Court E
CityStateZip CodeCounty
HomosassaFL34446Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600869 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME70061Radiology - Diagnostic - Minor Surgery3101

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
2/12/200210/14/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Free air in peritoneal cavity
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
CT Scan
Diagnostic Code :562.11
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to identify and treat free air
Principal Injury Giving Rise To The Claim
Diverticulitis of colon
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/5/2004H-27-CA-2004-385-DM
County Suit Filed inDate of Final Disposition
Hernando11/30/2005
Other Defendants Involved in this Claim
Kanuri, MD, Ramakrishna
Piduri, MD, Mallik
Flatau, MD, Arthur
Pasco Hernando Surgical Assoc.
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
11/30/2005
 
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$24,860
All Other Loss Adjustment Expense Paid$13,347
Injured Person's Total Non-Economic Loss$250,000
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
 
No updates found.

 

 

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Dr. Fawzi Soliman Medical Malpractice Lawsuits - Court Case # H27-CA-2002-1719-DM

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200640896
Claim Number :00-0259
Date Submitted :6/5/2006
 
Insurer Information
 
Insurer NameCoverage Type
CLARENDON NATIONAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
52-0266645 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancy Thomas
Street Address
9821 Katy Freeway, Suite 600
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 243 - 7311nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualFawzi Soliman
Insurer TypeStreet Address of Practice
Licensed12132 Cortez Blvd.
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMP0005135$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME39643Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Outpatient FacilityGulf Coast Surgery Center
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
10/28/19992/20/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient underwent endarterectomy and suffered brain hemorrhage
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Endarterectomy - plaintiff alleging negligent suturing of carotid artery
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Surgery related
Principal Injury Giving Rise To The Claim
Alleged negligent suturing of carotid artery during surgery resulting in paralysis, brain damage, loss of cognitive function, dysphagia and speech disorder
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/1/2002H27-CA-2002-1719-DM
County Suit Filed inDate of Final Disposition
Hernando6/1/2006
Other Defendants Involved in this Claim
Gulf Coast Surgery 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
2/24/2006
 
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$27,337
All Other Loss Adjustment Expense Paid$20,900
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
We have expert testimony that this procedure has a complication rate of 2-6% and they see no negligence in the performance of this surgery by Dr. Soliman
 
Updates
 
No updates found.

 

 

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Dr. A H ARMASHI Medical Malpractice Lawsuits - Court Case # H27-CA2004-226-DM

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200537276
Claim Number :20285-01
Date Submitted :10/12/2005
 
Insurer Information
 
Insurer NameCoverage Type
AMERICAN PHYSICIANS ASSURANCE CORPORATIONPrimary
Insurer FEINProfessional License Number
38-2102867 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancy Kirsch
Street Address
327 Plaza Real, Suite 319
CityStateZip
Boca RatonFL33432
PhoneExtFaxE-Mail Address
(561) 362 - 3332 (561) 417 - 6125nkirsch@acaponline.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualAHARMASHI
Insurer TypeStreet Address of Practice
Licensed12228 Cortez Blvd.
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
127679$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME66828Anesthesiology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
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
4/3/200210/2/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Chronic neck and back pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Epidural injection of steroids for pain control.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
It is alleged that the injection needle injured spinal cord causing RSD and significant loss of use of left arm.
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
2/26/2004H27-CA2004-226-DM
County Suit Filed inDate of Final Disposition
Hernando9/26/2005
Other Defendants Involved in this Claim
Hernando Anesthesia Associates, P.A. d/b/a Active Pain Contr
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
9/6/2005
 
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$44,050
All Other Loss Adjustment Expense Paid$18,419
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
Insured consulted with claims personnel and defense counsel.$250,000.00 was paid in full and final settlement of all claims on behalf of the insured.
 
Updates
 
No updates found.

 

 

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

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Dr. Paul Velt Medical Malpractice Lawsuits - Court Case # CA2007-2662

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201057363
Claim Number :28116
Date Submitted :5/19/2010
 
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
IndividualPaul Velt
Insurer TypeStreet Address of Practice
Licensed500 Vonderburg Drive Suite 111
CityStateZip CodeCounty
BrandonFL33511Hillsborough
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600551 10$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME73819Radiology - Diagnostic - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
7/22/20059/2/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Ventral hernia resulting in sepsis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Laparoscopic repair of hernia
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose a perforated bowel on CT scan
Principal Injury Giving Rise To The Claim
Sepsis
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/22/2009CA2007-2662
County Suit Filed inDate of Final Disposition
Hernando5/11/2010
Other Defendants Involved in this Claim
Palmer, MD, Kevin
West Coast Surgical Assoc.
Spring Hill Regional 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
5/11/2010
 
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$24,853
All Other Loss Adjustment Expense Paid$20,174
Injured Person's Total Non-Economic Loss$250,000
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
 
No updates found.

 

 

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Dr. M J Marcus Medical Malpractice Lawsuits - Court Case # 2012-CA-002072

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201469393
Claim Number :33525
Date Submitted :1/13/2014
 
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
IndividualMJMarcus
Insurer TypeStreet Address of Practice
Licensed821 Medical Court East
CityStateZip CodeCounty
InvernessFL34452Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1616028 01$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME20810Otorhinolaryngology - 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
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
2/15/20103/26/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
TIAs
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 TIAs
Principal Injury Giving Rise To The Claim
Stroke
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/6/20122012-CA-002072
County Suit Filed inDate of Final Disposition
Hernando1/2/2014
Other Defendants Involved in this Claim
Access Healthcare
Barnhurst, PA, Mark A
Gonzalez, MD, Mariel
Citrus Memorial Hospital
Zeljko, MD, Tomislav
Physicians of Central Florida, PA
Farag, MD, Nagy
Brady, ARNP, Craig
Phoenix Emergency Services of Inverrness
Tatambhotla, MD, Goptal
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
1/2/2014
 
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$103,746
All Other Loss Adjustment Expense Paid$41,441
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$140,000$0
Wage Loss$0$0
Other Expenses$8,230$7,200
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. John A Manubay Medical Malpractice Lawsuits - Court Case # CA093545

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263881
Claim Number :283919
Date Submitted :5/16/2012
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSusan KSpielman
Street Address
5814 Reed Road
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340  reportaclaim@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJohnAManubay
Insurer TypeStreet Address of Practice
Licensed14540 Cortez Blvd, Ste 123
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
631160$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME75741Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/7/20074/20/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hernia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Surgical repair
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper treatment and delay in diagnosis
Principal Injury Giving Rise To The Claim
Hypoxic brain damage with amputations
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
11/16/2009CA093545
County Suit Filed inDate of Final Disposition
Hernando5/16/2012
Other Defendants Involved in this Claim
Oak Hill Hospital
West Coast Surgical Associates PL
Palmer MD, Kevin
Piduru MD, Mallik A
Nature Coast Surgical Associates PA
Abuzarad MD, Husam
Physicians Partners Network PA
Bourghli MD, Mahmoud
Delta Health PA
Menendez MD, Francisco
Gil MD, Surrinder
Soliman MD, FawziM
Fawzi M Soliman MD PA dba Gulf Coast Surg Ctr
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
10/4/2011
 
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$27,229
All Other Loss Adjustment Expense Paid$9,943
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
N/A
 
Updates
 
No updates found.

 

 

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Dr. Kevin V Palmer Medical Malpractice Lawsuits - Court Case # CA093545

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264434
Claim Number :5140577-01
Date Submitted :9/23/2013
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSusan KSpielman
Street Address
5814 Reed Road
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340  reportaclaim@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKevinVPalmer
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd, Ste 201
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
733257$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME70806Surgery - Vascular 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/7/20074/20/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hernia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Surgical Repair
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper treatment and delay in diagnosis
Principal Injury Giving Rise To The Claim
Hypoxic brain damage with amputations
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
11/16/2009CA093545
County Suit Filed inDate of Final Disposition
Hernando7/18/2012
Other Defendants Involved in this Claim
HCA Health Services of Florida Inc dba Oak Hill Hospital
Piduru MD, Mallik A
West Coast Surgical Associates PL
Manubay MD, John A
Nature Coast Surgical Associates PA
Abuzarad MD, Husam
Physicians Partners Network PA
Bourghli MD, Mahmoud
Delta Health PA
Menendez MD, Francisco
Gil MD, Surrinder
Soliman MD, FawziM
Fawzi M Soliman MD PA dba Gulf Coast Surgery Ctr
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
3/27/2012
 
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$33,720
All Other Loss Adjustment Expense Paid$12,031
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
N/A
 
Updates
 
 
Date of Change:2/15/2013 12:10:57 PM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid1202412031
Amount of Loss Adjustment Expense Paid to Defense Counsel3228633713
 
Date of Change:9/23/2013 3:01:07 PM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel3371333720

 

 

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Dr. John A Manubay Medical Malpractice Lawsuits - Court Case # CA093545

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264435
Claim Number :5140577-03
Date Submitted :2/15/2013
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSusan KSpielman
Street Address
5814 Reed Road
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340  reportaclaim@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJohnAManubay
Insurer TypeStreet Address of Practice
Licensed14540 Cortez Blvd, Ste 123
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
631160$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME75741Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/7/20074/20/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hernia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Surgical Repair
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper treatment and delay in diagnosis
Principal Injury Giving Rise To The Claim
Hypoxic brain damage with amputations
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
11/16/2009CA093545
County Suit Filed inDate of Final Disposition
Hernando7/18/2012
Other Defendants Involved in this Claim
Piduru MD, Mallik A
Palmer MD, Kevin
West Coast Surgical Associates PL
Nature Coast Surgical Associates PA
Aabuzarad MD, Husam
HCA Health Services of Florida Inc dba Oak Hill Hospital
Physicians Partners Network PA
Bourghli MD, Mahmoud
Delta Health PA
Menendez MD, Francisco
Gil MD, Surrinder
Soliman MD, FawziM
Fawzi M Soliman MD PA dba Gulf Coast Surgery Ctr
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
10/4/2011
 
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$29,739
All Other Loss Adjustment Expense Paid$11,869
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
N/A
 
Updates
 
 
Date of Change:2/15/2013 1:12:03 PM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel2948329739
All Other Loss Adjustment Expense Paid1186811869

 

 

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Dr. Mallik A Piduru Medical Malpractice Lawsuits - Court Case # CA093545

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264436
Claim Number :5140577-04
Date Submitted :2/15/2013
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSusanKSpielman
Street Address
5814 Reed Road
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340  reportaclaim@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMallikAPiduru
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd, Ste 201
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
733261$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME44053Surgery - Vascular 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/7/20074/20/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hernia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Surgical Repair
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper treatment and delay in diagnosis
Principal Injury Giving Rise To The Claim
Hypoxic brain damage with amputations
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
11/16/2009CA093545
County Suit Filed inDate of Final Disposition
Hernando7/18/2012
Other Defendants Involved in this Claim
HCA Health Services of Florida Inc dba Oak Hill Hospital
Palmer MD, Kevin
West Coast Surgical Associates PL
Manubay MD, John A
Nature Coast Surgical Associates PA
Abuzarad MD, Husam
Physicians Partners Network PA
Bourghli MD, Mahmoud
Delta Health PA
Menendez MD, Francisco
Gil MD, Surrinder
Soliman MD, FawziM
Fawzi M Soliman MD PA dba Gulf Coast Surgery Ctr
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
3/27/2012
 
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$35,453
All Other Loss Adjustment Expense Paid$11,985
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
N/A
 
Updates
 
 
Date of Change:9/17/2012 3:34:29 PM
Reason for Change:ALE UPDATE
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid1186811985
Amount of Loss Adjustment Expense Paid to Defense Counsel2948333892
 
Date of Change:2/15/2013 1:13:52 PM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel3389235453

 

 

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Dr. Kevin Palmer Medical Malpractice Lawsuits - Court Case # CA-2007-2662

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201265397
Claim Number :131198
Date Submitted :11/19/2012
 
Insurer Information
 
Insurer NameCoverage Type
NATIONAL FIRE INSURANCE COMPANY OF HARTFORDPrimary
Insurer FEINProfessional License Number
06-0464510 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTeresa Ross
Street Address
One Park Plaza P.O. Box 555
CityStateZip
NashvilleTN37202
PhoneExtFaxE-Mail Address
(615) 344 - 5804  Teresa.Ross@HCAHealthcare.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKevin Palmer
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd #201
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ2075006282$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME70806Physicians or Surgeons - Major Surgery.NOC classification.01

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FPasco
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
7/22/20055/2/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Ventral hernia.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient underwent elective ventral hernia repair on 7/22/05 by laparoscopy.Between 7/22/05 postoperative period & 7/25/05 she deteriorated. She was returned to surgery on 7/25/05 where three small perforations were found that were approximately 2 inches long. They were repaired, mesh was removed & end-to-end anastomosis was done. She remained in the ICU & had a very stormy hospital course complicated by respiratory failure, requiring trachesotomy, sepsis, acute renal failure, anemia, hyperthermia, encephalopathy, intra-abdominal infection, peritonitis, fungal aortic valve endocarditis, & C-diff.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Three small bowel perforations.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
12/12/2007CA-2007-2662
County Suit Filed inDate of Final Disposition
Hernando11/12/2012
Other Defendants Involved in this Claim
Spring Hill Regional 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
10/31/2012
 
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$316,738
All Other Loss Adjustment Expense Paid$193,492
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$250,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Review of policies and procedures.
 
Updates
 
No updates found.

 

 

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

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Dr. Krishna Ganti Medical Malpractice Lawsuits - Court Case # CA-11-748

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201265414
Claim Number :41076-01
Date Submitted :11/19/2012
 
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
IndividualKrishna Ganti
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd., Ste 203
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
46540$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME48997Surgery - Otorhinolaryngology80159

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
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
10/20/200612/10/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Mass on neck and tongue.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Exam and FNA of neck lesion which was benign.Patient advised of need for surgical biopsy and refused.Patient stated he was unaware of tongue lesion.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Patient alleged 3-year delay in diagnosis of tongue cancer.
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
4/22/2011CA-11-748
County Suit Filed inDate of Final Disposition
Hernando10/22/2012
Other Defendants Involved in this Claim
Bikkasani, M.D., Naveen
Advanced Imaging Concepts
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
10/22/2012
 
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$16,969
All Other Loss Adjustment Expense Paid$5,969
Injured Person's Total Non-Economic Loss$250,000
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. Vincent T Buckman Medical Malpractice Lawsuits - Court Case # CA-09-3473

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367023
Claim Number :269132
Date Submitted :5/8/2013
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTiffanyDTaylor
Street Address
13450 West Sunrise Blvd
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(877) 320 - 0748  TTaylor@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualVincentTBuckman
Insurer TypeStreet Address of Practice
Licensed8425 Balm Street
CityStateZip CodeCounty
Weeki WacheeFL34607Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0070439$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME91222Family Physicians or General Practitioners - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
N/A000000
Location of Institutional InjuryOther Location of Institutional Injury
OtherPhysician's Office
Date of OccurrenceDate Reported to Insurer
2/22/20074/15/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient presented for complaints of diffuse abdominal pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Urine culture performed.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged failure to obtain a complete history from the patient including a list of current medications resulting in liver failure and requiring a liver transplant.
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/16/2009CA-09-3473
County Suit Filed inDate of Final Disposition
Hernando5/7/2013
Other Defendants Involved in this Claim
Quest Diagnostics Incorporated
Quest Diagnostics Clinical Laboratories
Heron Springs Family Medicine, 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
 
 
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$251,000
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$250,000$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.

 

 

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

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Dr. Robert L Hartzell Medical Malpractice Lawsuits - Court Case # H27-CA2002-1328-DM

Indemnity Paid: $245,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200537984
Claim Number :A01-25212-99
Date Submitted :11/4/2005
 
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 Drive, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRobertLHartzell
Insurer TypeStreet Address of Practice
Licensed4107 Daisy Drive
CityStateZip CodeCounty
Spring HillFL34607Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
16212$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME53790Family Physicians or General Practitioners - No Surgery80239

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
9/13/199912/14/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
14 year old with history of Crohns was admitted with abdominal pain, nausea, vomitting and marked weakness.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient developed hemiparesis and neuro consult was ordered.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Death secondary to CVA.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/5/2002H27-CA2002-1328-DM
County Suit Filed inDate of Final Disposition
Hernando10/11/2005
Other Defendants Involved in this Claim
Mwaisela, M.D., Francis
Spring Hill 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$245,000
Loss Adjust Expense Paid to Defense Counsel$49,703
All Other Loss Adjustment Expense Paid$28,814
Injured Person's Total Non-Economic Loss$245,000
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. Samir Shakfeh Medical Malpractice Lawsuits - Court Case # H 27 CA 2003 374

Indemnity Paid: $240,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200535236
Claim Number :071379
Date Submitted :5/17/2005
 
Insurer Information
 
Insurer NameCoverage Type
TDC SPECIALTY INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
95-4241120 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSallyLCleaver
Street Address
12121 Wilshire Blvd., Suite 601
CityStateZip
Los AngelesCA90025
PhoneExtFaxE-Mail Address
(310) 571 - 0730523(310) 571 - 0886scleaver@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualSamir Shakfeh
Insurer TypeStreet Address of Practice
Licensed221 MARINER BLVD
CityStateZip CodeCounty
SPRING HILLFL34609-5692Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
P90875-03$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME62854Surgery - Obstetrics - Gynecology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
1/26/200112/23/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient suffered from fibroids, pelvic adhesions, and pelvic pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient underwent total abdominal hysterectomy & bilateral salpingo-oophorectomy. Insured's op report indicated the fascia was closed.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Patient alleged insured failed to close fascia & failed to timely dx bowel obstruction necessitating second surgery resulting in abdominal bloating, discomfort, pain, scarring, & decreased ability to work.
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
4/1/2003H 27 CA 2003 374
County Suit Filed inDate of Final Disposition
Hernando4/25/2005
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
4/25/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$240,000
Loss Adjust Expense Paid to Defense Counsel$50,954
All Other Loss Adjustment Expense Paid$28,835
Injured Person's Total Non-Economic Loss$53,000
Deductible$20,000
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$187,000$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. Mallik Piduru Medical Malpractice Lawsuits - Court Case # 2016-CA-180

Indemnity Paid: $225,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201783621
Claim Number : 43844-1
Date Submitted : 11/10/2017
 
Insurer Information
 
Insurer Name Coverage Type
LANCET INDEMNITY RISK RETENTION GROUP INC. Primary
Insurer FEIN Professional License Number
26-1479165  
Insurer Contact Information
Type First Name MI Last Name
Individual Christopher   Teter
Street Address
2810 West St. Isabel Street Suite 100
City State Zip
Tampa FL 33602
Phone Ext Fax E-Mail Address
(813) 290 - 8282 265   cteter@lancetindemnity.com
 
Insured Information
 
Type First Name MI Last Name
Individual Mallik   Piduru
Insurer Type Street Address of Practice
Licensed 11373 CORTEZ BLVD #201
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
LR091393002547 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME44053 Surgery - General  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
OAK HILL HOSPITAL 100264
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
3/3/2014 4/16/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Treatment was sought for abdominal pain resulting in need for a lap chole.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
A lap chole was performed.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged bleed post surgery that resulted in 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
3/29/2016 2016-CA-180
County Suit Filed in Date of Final Disposition
Hernando 10/17/2017
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/17/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $225,000
Loss Adjust Expense Paid to Defense Counsel $27,730
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 $225,000 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurer is unaware of what steps have been taken.
 
Updates
 
No updates found.

 

 

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

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Dr. Naveen Bikkasani Medical Malpractice Lawsuits - Court Case # 2017-CA-000004

Indemnity Paid: $225,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782975
Claim Number : 158588
Date Submitted : 9/7/2017
 
Insurer Information
 
Insurer Name Coverage Type
FD INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
20-3704679  
Insurer Contact Information
Type First Name MI Last Name
Individual Steven R Carey
Street Address
4651 Salisbury Rd. Suite 410
City State Zip
Jacksonville FL 32256
Phone Ext Fax E-Mail Address
(904) 309 - 8127   (904) 309 - 8127 scarey@norcal-group.com
 
Insured Information
 
Type First Name MI Last Name
Individual Naveen   Bikkasani
Insurer Type Street Address of Practice
Licensed 13063 Cortez Blvd
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
MG000839 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME92555 Radiology - interventional  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Radiology, Emergency Room  
Date of Occurrence Date Reported to Insurer
3/12/2013 9/19/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Brain Cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Brain MRI
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Plaintiff maintains that Dr. Bikkasani was negligent and acted below the standard of care by failing to interpret the 3/12/13 study and report a possible tumor, failing to obtain diffusion weighted images, inappropriately reporting an early subacute infarct in the absence of diffusion weighted imaging, and failing to treat the Plaintiff within the applicable standard of care.
Principal Injury Giving Rise To The Claim
Brain Cancer
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
12/30/2016 2017-CA-000004
County Suit Filed in Date of Final Disposition
Hernando 8/27/2017
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
Other Settled between parties
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/22/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $225,000
Loss Adjust Expense Paid to Defense Counsel $15,971
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
Circumstances of the case have been discussed with the insured and risk management
 
Updates
 
No updates found.

 

 

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Dr. Mowaffak Atfeh Medical Malpractice Lawsuits - Court Case # CA-11-102

Indemnity Paid: $220,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161737
Claim Number :167656
Date Submitted :6/8/2012
 
Insurer Information
 
Insurer NameCoverage Type
PROASSURANCE CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
38-2317569 
Insurer Contact Information
TypeEntity Name
EntityProAssurance Casualty Company
Street Address
14497 North Dale Mabry Hwy., Suite 115-N
CityStateZip
TampaFL33618-2047
PhoneExtFaxE-Mail Address
(813) 969 - 2010 (813) 969 - 2120SNorris@ProAssurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMowaffak Atfeh
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd., Suite 307
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MP37519$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME54349Cardiovascular Disease - Minor Surgery00000

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Special Procedure Room 
Date of OccurrenceDate Reported to Insurer
10/14/20089/13/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Ventricular hypertrophy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Intravascular untrasound.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis.
Principal Injury Giving Rise To The Claim
Dissection of coronary artery.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/9/2011CA-11-102
County Suit Filed inDate of Final Disposition
Hernando9/7/2011
Other Defendants Involved in this Claim
M. Atfeh, M.D., P.A.
BROOKS, ANDRE M
Heart of Florida Cardiovascular Consultants, P.A.
HCA Health Services of Florida d/b/a Oak Hill 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
9/12/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$220,000
Loss Adjust Expense Paid to Defense Counsel$25,440
All Other Loss Adjustment Expense Paid$4,901
Injured Person's Total Non-Economic Loss$220,000
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
Insured has discussed case with insurance company personnel, medical experts and defense counsel.
 
Updates
 
 
Date of Change:6/8/2012 2:16:16 PM
Reason for Change:State Report updated to reflect additional legal fees and expenses paid.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel1989025440
All Other Loss Adjustment Expense Paid49104901

 

 

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Dr. ROBERT WEAVER Medical Malpractice Lawsuits - Court Case # H-27-CA-2003-1106-DM

Indemnity Paid: $215,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200534584
Claim Number :17988
Date Submitted :3/10/2005
 
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
IndividualROBERT WEAVER
Insurer TypeStreet Address of Practice
Licensed13 Mastic Court E
CityStateZip CodeCounty
HomosassaFL34446Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600869 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME70061Radiology - Diagnostic - No Surgery3101

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
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
7/2/20016/20/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Chest pain and nausea
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Chest x-ray
Diagnostic Code :DC231.2
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose lung cancer
Principal Injury Giving Rise To The Claim
Lung cancer
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/31/2003H-27-CA-2003-1106-DM
County Suit Filed inDate of Final Disposition
Hernando3/1/2005
Other Defendants Involved in this Claim
Oak Hill Hospital
Mehta, MD, Dilip A
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
3/1/2005
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$215,000
Loss Adjust Expense Paid to Defense Counsel$19,500
All Other Loss Adjustment Expense Paid$11,000
Injured Person's Total Non-Economic Loss$215,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$53,000$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. Gaurav Malhotra Medical Malpractice Lawsuits - Court Case # H-27-CA-2003-36-DM

Indemnity Paid: $207,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432138
Claim Number :83-008663
Date Submitted :7/26/2004
 
Insurer Information
 
Insurer NameCoverage Type
TRUCK INSURANCE EXCHANGEPrimary
Insurer FEINProfessional License Number
95-2575892 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualDeanon Davis
Street Address
4601 Wilshire Blvd., Suite 100
CityStateZip
Los AngelesCA90010
PhoneExtFaxE-Mail Address
(323) 930 - 6346  deanon.davis@farmersinsurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualGaurav Malhotra
Insurer TypeStreet Address of Practice
Licensed433 Jefferson Street
CityStateZip CodeCounty
BrooksvilleFL34601Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
011808857-0000$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME76833Internal Medicine - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Special Procedure Room 
Date of OccurrenceDate Reported to Insurer
5/17/200110/7/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented to "rule out chest pain."Ultimately, the Plaintiff sustained a heart attack resulting in heart transplant.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
A diagnostic Thallium stress test was performed which was interpreted as being negative by another party.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis was made by this particular party.The Cardiologist interpreted the Thallium stress test as negative.He failed to diagnose a heart condition.
Principal Injury Giving Rise To The Claim
Heart attack resulting in heart transplant.
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
1/14/2003H-27-CA-2003-36-DM
County Suit Filed inDate of Final Disposition
Hernando6/14/2004
Other Defendants Involved in this Claim
Kahn, Abdul
A.R. Kahn, M.D., P.A., The Heart Place
Brooksville Walk-In Clinic, LLC
Central Walk-In Clinic, Inc.
Springhill Walk-In Clinic
Muftah, Azzam
Azzam Muftah, M.D., P.A.
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
7/2/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$207,500
Loss Adjust Expense Paid to Defense Counsel$29,573
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$103,750
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$250,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
None, since this was we felt the fault of the cardiologist.
 
Updates
 
No updates found.

 

 

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Dr. Ramanujam K Setlur Medical Malpractice Lawsuits - Court Case # 1827CA2006-45DM

Indemnity Paid: $205,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200745276
Claim Number :HM089810
Date Submitted :4/17/2007
 
Insurer Information
 
Insurer NameCoverage Type
CONTINENTAL CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
36-2114545 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancy Pistilli-Hurst
Street Address
7886 Woodland Canter Blvd
CityStateZip
TampaFL33614
PhoneExtFaxE-Mail Address
(813) 880 - 51005123(813) 880 - 5105nancy.pistilli-hurst@cna.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRamanujamKSetlur
Insurer TypeStreet Address of Practice
Licensed14539 Cortez Blvd
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
DLP03959122$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Dentistry 
License NumberSpecialty Code & ClassificationCertification Number
DN9313Dentists 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
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
9/1/20039/25/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
missing teeth
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
implants and bridgework
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
failed implants
Principal Injury Giving Rise To The Claim
failed implants, bone loss and periodontal disease
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
1/12/20061827CA2006-45DM
County Suit Filed inDate of Final Disposition
Hernando4/12/2007
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
4/16/2007
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$205,000
Loss Adjust Expense Paid to Defense Counsel$12,070
All Other Loss Adjustment Expense Paid$5,303
Injured Person's Total Non-Economic Loss$151,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$52,000
Wage Loss$2,000$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Discussed referral of perio patients to periodontist and implant specialist.
 
Updates
 
No updates found.

 

 

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Dr. Michael Moore Medical Malpractice Lawsuits - Court Case # H27CA2009-000436

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201058753
Claim Number :28759
Date Submitted :10/11/2010
 
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
IndividualMichael Moore
Insurer TypeStreet Address of Practice
Licensed11373 Cortez Blvd.
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600390 08$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
OS9217Internal Medicine - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Special Procedure Room 
Date of OccurrenceDate Reported to Insurer
7/5/200611/3/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Coronary artery disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Cahteterization
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform catheterization
Principal Injury Giving Rise To The Claim
Retroperitoneal bleed
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/10/2009H27CA2009-000436
County Suit Filed inDate of Final Disposition
Hernando9/15/2010
Other Defendants Involved in this Claim
Oak Hill Hospital
Stage of Legal System at which Settlement was Reached or Award Made
Within 90 days of suit being filed.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
9/15/2010
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$200,000
Loss Adjust Expense Paid to Defense Counsel$28,475
All Other Loss Adjustment Expense Paid$10,979
Injured Person's Total Non-Economic Loss$200,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$138,000$0
Wage Loss$100,000$150,000
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. MOHAMMED TABBAA Medical Malpractice Lawsuits - Court Case # 16-CA-785

Indemnity Paid: $200,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782333
Claim Number : 156534
Date Submitted : 5/25/2018
 
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 Teresa   Ross
Street Address
One Park Plaza P.O. Box 555
City State Zip
Nashville TN 37202
Phone Ext Fax E-Mail Address
(615) 344 - 5804     Teresa.Ross@HCAHealthcare.com
 
Insured Information
 
Type First Name MI Last Name
Individual MOHAMMED   TABBAA
Insurer Type Street Address of Practice
Licensed 221 MARINER BLVD
City State Zip Code County
SPRING HILL FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HCI-10114 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME115376 Surgery - Obstetrics - Gynecology 01

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Labor and Delivery Room  
Date of Occurrence Date Reported to Insurer
8/21/2014 10/27/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Premature labor & bleeding @ 33 weeks gestation.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Allege delay in performing C-section resulting in fetal demise.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
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
6/20/2016 16-CA-785
County Suit Filed in Date of Final Disposition
Hernando 5/25/2018
Other Defendants Involved in this Claim
SHAKFEH, M.D., SAMIR MOHAMMAD
Advanced Women's Health Center, Inc.
Bayfront Health Spring Hill
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
5/12/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $200,000
Loss Adjust Expense Paid to Defense Counsel $50,440
All Other Loss Adjustment Expense Paid $9,621
Injured Person's Total Non-Economic Loss $150,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $50,000 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
REVIEW OF POLICIES AND PROCEDURES.
 
Updates
 
 
Date of Change: 7/6/2017 9:55:34 AM
Reason for Change: Additional LAE payments made.
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 49213 50415
All Other Loss Adjustment Expense Paid 9619 9620
 
Date of Change: 5/25/2018 1:41:00 PM
Reason for Change: ADDITIONAL LAE PAYMENTS MADE.
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 50415 50440
Insured Address Street 221 Mariner Blvd. 221 MARINER BLVD
Date of Final Disposition 06-JUN-17 25-MAY-18
All Other Loss Adjustment Expense Paid 9620 9621
Injured Person Address Street 3646 Flamingo Blvd. 3646 FLAMINGO BLVD

 

 

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Dr. Val E Haddon Medical Malpractice Lawsuits - Court Case # 2015-CA-391

Indemnity Paid: $200,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201679323
Claim Number : 21511-01
Date Submitted : 8/3/2016
 
Insurer Information
 
Insurer Name Coverage Type
PODIATRY INSURANCE COMPANY OF AMERICA Primary
Insurer FEIN Professional License Number
58-1403235  
Insurer Contact Information
Type First Name MI Last Name
Individual Karen   Kessler
Street Address
3000 Meridian Blvd., Suite 400
City State Zip
Franklin TN 37067
Phone Ext Fax E-Mail Address
(615) 371 - 8776 2249   kkessler@picagroup.com
 
Insured Information
 
Type First Name MI Last Name
Individual Val E Haddon
Insurer Type Street Address of Practice
Licensed 38105 - 13th Ave.
City State Zip Code County
Zephyrhills FL 33542 Hillsborough
Policy Number Per Claim Policy Limits Aggregate Policy Limits
1PD0045786 $250,000 $750,000
Profession or Business Other Profession or Business
Podiatric Physician  
License Number Specialty Code & Classification Certification Number
PO3491    

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 Hillsborough
City State Zip Code
     
Location where injury occured Other location where injury occured
Patient's Home  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
   
Date of Occurrence Date Reported to Insurer
1/22/2014 12/5/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Ingrown hallux nails, bilateral
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Nail debridement, bilateral
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Diabetic patient was initially evaluated by the insured on 1/17/14 with problems associated with recurrent ingrown nails involving each hallux. Pulses were intact, and the nails were debrided. Five days later the patient presented with complaints of pain involving the plantar right heel consistent with plantar fasciitis. Radiographs demonstrated a plantar calcaneal spur along with vascular calcification. The heel was injected with steroid, and antibiotics were changed for the hallux. On 1/31/14, the calluses were debrided, fissures were noted involving the heel, and a low dye strapping was applied. The last visit with insured was on 2/19/14. The fascial symptoms had improved, and the skin fissures were better but still painful. On 2/27/14, patient was admitted to the hospital with secondary sepsis. Surgery was performed on 3/6/14 in an attempt to restore blood flow to the extremity. The anterior tibial artery was opened, but the posterior tibial artery was so occluded that this could not be improved. The patient was discharged from the hospital, but had issues relative to the wound, which failed to improve, and issues with recurrent infection. A right below knee amputation was performed on 5/23/14. Patient alleges the amputation occurred because insured incorrectly diagnosed him with plantar fasciitis.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
4/1/2015 2015-CA-391
County Suit Filed in Date of Final Disposition
Hernando 8/2/2016
Other Defendants Involved in this Claim
Ankle & Foot Center of Tampa Bay, P.A.
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
8/2/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $200,000
Loss Adjust Expense Paid to Defense Counsel $48,427
All Other Loss Adjustment Expense Paid $11,181
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $360,000 $75,000
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
None - Specialty code #80993
 
Updates
 
No updates found.

 

 

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

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Dr. Gaurav Malhotra Medical Malpractice Lawsuits - Court Case # CA-13-998

Indemnity Paid: $200,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201472253
Claim Number : 12-0285-B-12
Date Submitted : 10/8/2014
 
Insurer Information
 
Insurer Name Coverage Type
FD INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
20-3704679  
Insurer Contact Information
Type First Name MI Last Name
Individual Linda D Collins
Street Address
4651 Salisbury Road, Suite 410
City State Zip
Jacksonville FL 32256
Phone Ext Fax E-Mail Address
(904) 296 - 2887 214 (904) 296 - 1245 lcollins@fldic.com
 
Insured Information
 
Type First Name MI Last Name
Individual Gaurav   Malhotra
Insurer Type Street Address of Practice
Licensed 11077 Spring Hill Drive
City State Zip Code County
Spring Hill FL 34608 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
GL01000038 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME76833 Internal Medicine - 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
5/24/2012 12/18/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented to the hospital with complaints of abdominal pain. Surgery was performed and a mass removed by another physician. This insured was called to discharge the patient.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Discontinue use of Heparin.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None made.
Principal Injury Giving Rise To The Claim
Alleged failure to evaluate patient for risk of DVT or pulmonary emboli; alleged inappropriately discontinued Heparin; and alleged failure to initiate proper treatment upon discovery of patient's shortness of breath resulting in 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
4/2/2013 CA-13-998
County Suit Filed in Date of Final Disposition
Hernando 9/10/2014
Other Defendants Involved in this Claim
Hernando HMA, LLC d/b/a Spring Hill Regional Hospital
Manubay, M.D., John
Malhotra, M.D., Poonam
Brooksville Walk In Clinic, LLC
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
9/10/2014
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $200,000
Loss Adjust Expense Paid to Defense Counsel $28,729
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
Circumstances of this case have been discussed with the insured and Risk Management was notified.
 
Updates
 
No updates found.

 

 

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Dr. Daniel Vincent Medical Malpractice Lawsuits - Court Case # CA12-1175

Indemnity Paid: $200,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201573705
Claim Number : FP4238002
Date Submitted : 3/9/2015
 
Insurer Information
 
Insurer Name Coverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INC Primary
Insurer FEIN Professional License Number
59-6614702  
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 Daniel   Vincent
Insurer Type Street Address of Practice
Licensed 4714 N. Armenia Avenue, Suite 200
City State Zip Code County
Tampa FL 33603 Hillsborough
Policy Number Per Claim Policy Limits Aggregate Policy Limits
FP-CL105731 $500,000 $1,500,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME75546 Otology - No 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 Hillsborough
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
9/28/2010 11/2/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Acute pan sinusitis with left abducens nerve palsy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged delay in the diagnosis and treatment of diabetes mellitus.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged development of hyperosmolar state due to uncontrolled diabetes. Resulting in stroke with permanent neurological deficits.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
5/7/2012 CA12-1175
County Suit Filed in Date of Final Disposition
Hernando 2/20/2015
Other Defendants Involved in this Claim
Spring Hill Regional Hospital
Dolgin, Sanford
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
 
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $200,000
Loss Adjust Expense Paid to Defense Counsel $12,472
All Other Loss Adjustment Expense Paid $19,669
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
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate.
 
Updates
 
No updates found.

 

 

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

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Dr. Gerald Beinhauer Medical Malpractice Lawsuits - Court Case # CA-12-1910

Indemnity Paid: $200,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201471577
Claim Number :292737
Date Submitted :8/8/2014
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTiffanyDTaylor
Street Address
13450 West Sunrise Blvd
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(877) 320 - 0748  TTaylor@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualGerald Beinhauer
Insurer TypeStreet Address of Practice
Licensed13510 Carryback Drive
CityStateZip CodeCounty
Dade CityFL33525Pasco
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0427773$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME99940Family Physicians or General Practitioners - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOut of state
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
N/A000000
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
10/31/20091/27/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Cardiac catheterization and stent placement following myocardial infarction.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to recognize that patient's Plavix and aspirin had been discontinued by another physician and not restarted as needed.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
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
6/18/2012CA-12-1910
County Suit Filed inDate of Final Disposition
Hernando7/31/2014
Other Defendants Involved in this Claim
Herron, M.D., Michael
Brooksville Regional 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
7/18/2014
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$200,000
Loss Adjust Expense Paid to Defense Counsel$74,287
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.

 

 

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

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Dr. Alfred E Alingu Medical Malpractice Lawsuits - Court Case # H-27-CA-2003-862-DM

Indemnity Paid: $195,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200433495
Claim Number :17710
Date Submitted :11/23/2004
 
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
IndividualAlfredEAlingu
Insurer TypeStreet Address of Practice
Licensed5350 Spring Hill Drive
CityStateZip CodeCounty
Spring HillFL34606Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600367 02$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME77939Internal Medicine - No Surgery3305

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
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
4/3/20015/13/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Venous ulcer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Prescribed antibiotics
Diagnostic Code :707.1
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
Cellulitis/scarring
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/9/2003H-27-CA-2003-862-DM
County Suit Filed inDate of Final Disposition
Hernando11/12/2004
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
11/12/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$195,000
Loss Adjust Expense Paid to Defense Counsel$31,185
All Other Loss Adjustment Expense Paid$8,900
Injured Person's Total Non-Economic Loss$195,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$88,793$0
Wage Loss$0$0
Other Expenses$32,000$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. MAYLIN Y LOPEZ CORTES Medical Malpractice Lawsuits - Court Case # 2017-CA-356

Indemnity Paid: $187,500.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201885928
Claim Number : EMC-FL-360373
Date Submitted : 7/13/2018
 
Insurer Information
 
Insurer Name Coverage Type
EmCare Holdings, Inc. Primary
Insurer FEIN Professional License Number
75-173235 SI
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 MAYLIN Y LOPEZ CORTES
Insurer Type Street Address of Practice
Self-Insurer 1717 NORTH MAIN STREET, SUITE 5200
City State Zip Code County
DALLAS TX 75201 Out of state
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HAZ1040025381-14 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME117226 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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Emergency Room  
Name of Institution Code
SPRING HILL REGIONAL HOSPITAL 111525
Location of Institutional Injury Other Location of Institutional Injury
Other ER
Date of Occurrence Date Reported to Insurer
1/1/2015 9/16/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
ABSCESS
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
SEEN IN ER
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
ALLEGED FAILURE TO TREAT
Principal Injury Giving Rise To The Claim
LIFE THREATENING INFECTION
Severity Of Injury
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
4/7/2017 2017-CA-356
County Suit Filed in Date of Final Disposition
Hernando 7/13/2018
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
6/26/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $187,500
Loss Adjust Expense Paid to Defense Counsel $70,329
All Other Loss Adjustment Expense Paid $17,458
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. JATIN SHETH Medical Malpractice Lawsuits - Court Case # CA2007-2280

Indemnity Paid: $175,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201057327
Claim Number :25719
Date Submitted :5/17/2010
 
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
IndividualJATIN SHETH
Insurer TypeStreet Address of Practice
Licensed920 W. Jefferson St.
CityStateZip CodeCounty
BrooksvilleFL34601Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600367 06$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME87400Family Physicians or General Practitioners - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
BROOKSVILLE REGIONAL HOSPITAL 100071
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
8/27/20066/14/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
High grade small bowel obstruction leading to sepsis and death
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Failure to get timely surgical consult
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to get timely surgical consult
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
12/28/2007CA2007-2280
County Suit Filed inDate of Final Disposition
Hernando4/21/2010
Other Defendants Involved in this Claim
Brooksville 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
4/21/2010
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$175,000
Loss Adjust Expense Paid to Defense Counsel$146,687
All Other Loss Adjustment Expense Paid$69,824
Injured Person's Total Non-Economic Loss$175,000
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
 
No updates found.

 

 

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Dr. Mohammad Shuayb Medical Malpractice Lawsuits - Court Case # CA 13 492

Indemnity Paid: $175,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201472375
Claim Number : 2012-112400
Date Submitted : 10/17/2014
 
Insurer Information
 
Insurer Name Coverage Type
NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA Primary
Insurer FEIN Professional License Number
25-0687550  
Insurer Contact Information
Type First Name MI Last Name
Individual Connie L Peters
Street Address
PO Box 52810
City State Zip
Bellevue WA 98015
Phone Ext Fax E-Mail Address
(425) 636 - 1000 1012 (916) 781 - 5795 cpeters@intercareins.com
 
Insured Information
 
Type First Name MI Last Name
Individual Mohammad   Shuayb
Insurer Type Street Address of Practice
Licensed 229 Mariner Blvd
City State Zip Code County
Spring Hill FL 34609 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
DNU 003210942 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Dentistry  
License Number Specialty Code & Classification Certification Number
DN15081 Dental General Practice - NOC 80211

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Other Dental Treatment Room
Date of Occurrence Date Reported to Insurer
5/21/2012 10/18/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented with pain in tooth #32
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Insured extracted tooth #32
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis
Principal Injury Giving Rise To The Claim
Patient alleged infection post extraction and incorrect antibiotics.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
2/27/2013 CA 13 492
County Suit Filed in Date of Final Disposition
Hernando 8/5/2014
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
8/1/2014
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $175,000
Loss Adjust Expense Paid to Defense Counsel $21,739
All Other Loss Adjustment Expense Paid $4,467
Injured Person's Total Non-Economic Loss $102,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $73,000 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
No safety managment steps taken.
 
Updates
 
No updates found.

 

 

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Dr. Kevin V Palmer Medical Malpractice Lawsuits - Court Case # 2014-CA-000822

Indemnity Paid: $175,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201678538
Claim Number : 1014145-01
Date Submitted : 2/20/2017
 
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 Kevin V Palmer
Insurer Type Street Address of Practice
Licensed 11373 Cortez Blvd, Ste 201
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
733257 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME70806 Surgery - Vascular  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Outpatient Facility  
Name of Institution Code
BAYONET POINT SURGERY & ENDOSCOPY CENTER 14960565
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
2/23/2012 6/17/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Lymphadenopathy
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Removal of lymph node from posterior neck
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper performance of procedure
Principal Injury Giving Rise To The Claim
Pain; possible nerve damage
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
5/28/2014 2014-CA-000822
County Suit Filed in Date of Final Disposition
Hernando 5/10/2016
Other Defendants Involved in this Claim
Access Management Company LLC
Katz MD, Richard J
Katz Orthopaedic Institute LLC
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
5/9/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $175,000
Loss Adjust Expense Paid to Defense Counsel $43,673
All Other Loss Adjustment Expense Paid $16,221
Injured Person's Total Non-Economic Loss $169,000
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: 8/11/2016 9:28:15 AM
Reason for Change: ALE UPDATED 8/11/2016
 
Field Changed Former Value New Value
All Other Loss Adjustment Expense Paid 14779 16221
Amount of Loss Adjustment Expense Paid to Defense Counsel 38068 43640
 
Date of Change: 2/20/2017 1:22:17 PM
Reason for Change: ALE UPDATE 2/20/17
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 43640 43673

 

 

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Dr. Kevin V Palmer Medical Malpractice Lawsuits - Court Case # 13-CA-1927

Indemnity Paid: $165,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201574410
Claim Number : 1011746-01
Date Submitted : 1/27/2016
 
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 Susan K Spielman
Street Address
5814 Reed Road
City State Zip
Fort Wayne IN 46835
Phone Ext Fax E-Mail Address
(260) 486 - 0340     reportaclaim@medpro.com
 
Insured Information
 
Type First Name MI Last Name
Individual Kevin V Palmer
Insurer Type Street Address of Practice
Licensed 11373 Cortez Blvd, Ste 201
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
733257 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME70806 Surgery - Vascular  

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 Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
OAK HILL HOSPITAL 100264
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
10/17/2011 1/25/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abdominal pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Exam and surgery
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper performance
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
9/5/2013 13-CA-1927
County Suit Filed in Date of Final Disposition
Hernando 4/21/2015
Other Defendants Involved in this Claim
Piduru MD, Mallik
Healthcare Physicians LLC
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
4/20/2015
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $165,000
Loss Adjust Expense Paid to Defense Counsel $40,649
All Other Loss Adjustment Expense Paid $9,482
Injured Person's Total Non-Economic Loss $157,667
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: 8/25/2015 4:20:56 PM
Reason for Change: ALE UPDATE
 
Field Changed Former Value New Value
All Other Loss Adjustment Expense Paid 7722 9482
Amount of Loss Adjustment Expense Paid to Defense Counsel 35423 40517
 
Date of Change: 1/27/2016 3:01:08 PM
Reason for Change: ALE UPDATE 1/27/2016
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 40517 40649

 

 

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Dr. Azzam Muftah Medical Malpractice Lawsuits - Court Case # 2018-CA-000036

Indemnity Paid: $165,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201885336
Claim Number : 64114
Date Submitted : 5/18/2018
 
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 Azzam   Muftah
Insurer Type Street Address of Practice
Licensed 12900 Cortez Blvd. Ste. 203
City State Zip Code County
Brooksville FL 34613 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1602930 05 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME68485 Gastroenterology - 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
  F Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Outpatient Facility Endoscopy Center
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
9/24/2015 10/12/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Chronic constipation
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Colonoscopy
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged improper performance of colonoscopy
Principal Injury Giving Rise To The Claim
Perforation
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
1/25/2018 2018-CA-000036
County Suit Filed in Date of Final Disposition
Hernando 5/9/2018
Other Defendants Involved in this Claim
Access Health Care
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
5/9/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $165,000
Loss Adjust Expense Paid to Defense Counsel $18,812
All Other Loss Adjustment Expense Paid $4,076
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $36,000 $0
Wage Loss $0 $0
Other Expenses $0 $500,000
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. Andres Velasco Medical Malpractice Lawsuits - Court Case # CA 09 1712

Indemnity Paid: $162,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955621
Claim Number :SGI-06-83131-AV
Date Submitted :12/1/2009
 
Insurer Information
 
Insurer NameCoverage Type
The Schumacher GroupPrimary
Insurer FEINProfessional License Number
72-1383025 
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
IndividualAndres Velasco
Insurer TypeStreet Address of Practice
Self-Insurer4519 Chalfont Drive
CityStateZip CodeCounty
OrlandoFL32837Orange
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMI AE 0801 046$1,000,000$1,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME96936Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
5/13/200711/13/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Presented one day after being involved in MVA with complaints of muscle pain right side of neck, back pain, headache, eye not opening all the way
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Exam done and clinical impression was acute cervical, thoracic and lumbar strain.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to order appropriate tests
Principal Injury Giving Rise To The Claim
Failure to diagnose carotid artery occlusion resulting in stroke
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/1/2009CA 09 1712
County Suit Filed inDate of Final Disposition
Hernando11/30/2009
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 subject to arbitration, but settlement reached in lieu of award.
Date of Payment
11/24/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$162,500
Loss Adjust Expense Paid to Defense Counsel$14,467
All Other Loss Adjustment Expense Paid$2,498
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. Eddie Tumaneng Medical Malpractice Lawsuits - Court Case # CA 09 1712

Indemnity Paid: $162,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200955622
Claim Number :SGI-06-83131-ET
Date Submitted :12/1/2009
 
Insurer Information
 
Insurer NameCoverage Type
The Schumacher GroupPrimary
Insurer FEINProfessional License Number
72-1383025 
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
IndividualEddie Tumaneng
Insurer TypeStreet Address of Practice
Self-Insurer2012 Old Oak Lane
CityStateZip CodeCounty
Safety HarborFL34695Pinellas
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMI AE 0801 046$1,000,000$1,000,000
Profession or BusinessOther Profession or Business
OtherPhysician Assistant
License NumberSpecialty Code & ClassificationCertification Number
PA9103215  

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
5/13/200711/13/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Presented one day after being involved in MVA with complaints of muscle pain right side of neck, back pain, headache, eye not opening all the way
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Exam done and clinical impression was acute cervical, thoracic and lumbar strain.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to order appropriate tests
Principal Injury Giving Rise To The Claim
Failure to diagnose carotid artery occlusion resulting in stroke
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/1/2009CA 09 1712
County Suit Filed inDate of Final Disposition
Hernando11/30/2009
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 subject to arbitration, but settlement reached in lieu of award.
Date of Payment
11/24/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$162,500
Loss Adjust Expense Paid to Defense Counsel$14,467
All Other Loss Adjustment Expense Paid$2,498
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. Ramana Dutt Medical Malpractice Lawsuits - Court Case # 2016-CA-611

Indemnity Paid: $160,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782551
Claim Number : 1030584-01
Date Submitted : 2/9/2018
 
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 Ramana   Dutt
Insurer Type Street Address of Practice
Licensed 14529 Cortez Blvd
City State Zip Code County
Brooksville FL 34616 Hernando
Policy Number Per Claim Policy Limits Aggregate Policy Limits
772688 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME65892 Internal Medicine - 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
  F Hernando
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
   
Date of Occurrence Date Reported to Insurer
5/9/2011 1/4/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Bowel cancer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Chemotherapy and radiation
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to complete 5H1AA test and monitor symptoms
Principal Injury Giving Rise To The Claim
Increased morbidity, pain and suffering
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
5/10/2016 2016-CA-611
County Suit Filed in Date of Final Disposition
Hernando 7/5/2017
Other Defendants Involved in this Claim
Florida Cnncer Specialist PL
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
 
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $160,000
Loss Adjust Expense Paid to Defense Counsel $18,966
All Other Loss Adjustment Expense Paid $6,301
Injured Person's Total Non-Economic Loss $120,000
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: 2/9/2018 1:43:25 PM
Reason for Change: ALE UPDATE 2/9/2018
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 15422 18966
All Other Loss Adjustment Expense Paid 2142 6301

 

 

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Dr. BRADLEY STELLPFLUG Medical Malpractice Lawsuits - Court Case # CA 12 2338

Indemnity Paid: $150,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201677995
Claim Number : EMC-FL-11-151913
Date Submitted : 4/20/2016
 
Insurer Information
 
Insurer Name Coverage Type
CONTINENTAL CASUALTY COMPANY Primary
Insurer FEIN Professional License Number
36-2114545  
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 BRADLEY   STELLPFLUG
Insurer Type Street Address of Practice
Licensed 111375 CORTEZ BLVD.
City State Zip Code County
OAK HILL FL 32759 Volusia
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HAZ1040025381-9 $250,000 $750,000
Profession or Business Other Profession or Business
Osteopathic Physician  
License Number Specialty Code & Classification Certification Number
OS8784 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
  M Volusia
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Hospital/Institution COMMUNITY HOSPITAL OF OAK HILL
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
1/22/2011 9/21/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
ABDOMINAL AND CHEST PAIN
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
SEEN IN ER AND RELEASED.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
ESOPHAGEAL SPASM AND GERD
Principal Injury Giving Rise To The Claim
MI
Severity Of Injury
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
8/3/2012 CA 12 2338
County Suit Filed in Date of Final Disposition
Hernando 4/20/2016
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
Other SETTLED
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
3/24/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $150,000
Loss Adjust Expense Paid to Defense Counsel $27,599
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
UNKNOWN
 
Updates
 
No updates found.

 

 

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Dr. John A Manubay Medical Malpractice Lawsuits - Court Case # 2013-CA-998

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201471532
Claim Number :1011533-01
Date Submitted :8/4/2014
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualSusanKSpielman
Street Address
5814 Reed Road
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340  reportaclaim@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJohnAManubay
Insurer TypeStreet Address of Practice
Licensed11343 Cortez Blvd
CityStateZip CodeCounty
BrooksvilleFL34613Hernando
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
631160$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME75741Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
SPRING HILL REGIONAL HOSPITAL111525
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
5/23/20121/14/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Abdominal pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Colon resection
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Improper anticoagulation
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
4/29/20132013-CA-998
County Suit Filed inDate of Final Disposition
Hernando7/23/2014
Other Defendants Involved in this Claim
Spring Hill Regional Hospital
Nature Coast Surgical Associates PA
Malhotra MD, Guarav
Malhotra MD, Poonam
Brooksville Walk In Clinic LLC
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
7/21/2014
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$150,000
Loss Adjust Expense Paid to Defense Counsel$30,534
All Other Loss Adjustment Expense Paid$3,221
Injured Person's Total Non-Economic Loss$75,000
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
N/A
 
Updates
 
No updates found.

 

 

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Dr. Ayman Osman Medical Malpractice Lawsuits - Court Case # CA-2008-4223

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263083
Claim Number :28349
Date Submitted :6/26/2012
 
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
IndividualAyman Osman
Insurer TypeStreet Address of Practice
Licensed8355 Northcliffe Blvd.
CityStateZip CodeCounty
Spring HillFL34606Citrus
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1601897 04$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME69703Internal 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
Hospital Inpatient Facility 
Name of InstitutionCode
OAK HILL HOSPITAL100264
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
9/20/20079/26/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Infection
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 manage an infection in a diabetic patient
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
12/29/2008CA-2008-4223
County Suit Filed inDate of Final Disposition
Hernando5/2/2012
Other Defendants Involved in this Claim
Mahmaljy, MD, Ghiath
Hasan, MD, Syed S
Singh, MD, Pariksith
Howell, DO, N. Scott
Access Health Care
Abbey Prime Care
Oak Hill Hospital
West Coast Medical Care
Physician Partners Network
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
2/24/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$150,000
Loss Adjust Expense Paid to Defense Counsel$55,971
All Other Loss Adjustment Expense Paid$23,457
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$150,000$0
Wage Loss$0$315,000
Other Expenses$0$250,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:6/26/2012 11:13:02 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 05/02/12
 
Field ChangedFormer ValueNew Value
Date of Final Disposition24-FEB-1202-MAY-12

 

 

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Dr. James O Booker Medical Malpractice Lawsuits - Court Case # H27-CA2002-2972 DM

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200643664
Claim Number :A02-26407-01
Date Submitted :12/27/2006
 
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
IndividualJamesOBooker
Insurer TypeStreet Address of Practice
Licensed40 Veterans Avenue
CityStateZip CodeCounty
BrooksvilleFL34601Pasco
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
9255$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME47481Surgery - General80143

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MHernando
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
BROOKSVILLE REGIONAL HOSPITAL 100071
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
2/1/20016/17/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Suspected chronic cholecystitis.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Laparoscopic cholecystectomy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged improper diagnosis of chronic cholecystitis.
Principal Injury Giving Rise To The Claim
Biliary leak, resulting in need for subsequent surgeries.
Severity Of Injury
Temporary: Major - Burns, surgical material left, drug side effect, brain damage.Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
12/23/2002H27-CA2002-2972 DM
County Suit Filed inDate of Final Disposition
Hernando12/5/2006
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
12/5/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$150,000
Loss Adjust Expense Paid to Defense Counsel$28,253
All Other Loss Adjustment Expense Paid$32,484
Injured Person's Total Non-Economic Loss$150,000
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. Carl W Graves Medical Malpractice Lawsuits - Court Case # H-27-CA-2004-1251-DM

Indemnity Paid: $150,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200639157
Claim Number :A04-31010-00
Date Submitted :1/9/2006
 
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 Drive, Suite 800
CityStateZip
JacksonvilleFL32204
PhoneExtFaxE-Mail Address
(800) 741 - 37423043(904) 358 - 6728montague@fpic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualCarlWGraves
Insurer TypeStreet Address of Practice
Licensed13417 US Highway 301 South, Ste D
CityStateZip CodeCounty
Dade CityFL33525Pasco
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
63357$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME34076Family Physicians or General Practitioners - No Surgery80239

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MPasco
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
11/14/20006/30/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Prostate cancer.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
None.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to timely diagnose and treat prostate cancer due to serial elevated PSA results.
Principal Injury Giving Rise To The Claim
Spread of prostate cancer requiring post prostatectomy radiation, sexual dysfunction and depression.
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/5/2005H-27-CA-2004-1251-DM
County Suit Filed in