Medical Malpractice Cases

Medical Malpractice Cases In Lake County Florida

Dr. Ivan J Wortman Medical Malpractice Lawsuits - Court Case # 03CA3561

Indemnity Paid: $1,000,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200640476
Claim Number :852271
Date Submitted :2/3/2009
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Primary
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualPamelaAPrudlow
Street Address
5814 Reed Road
CityStateZip
Ft. WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0370 (260) 486 - 0785pamela.prudlow@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualIvanJWortman
Insurer TypeStreet Address of Practice
Licensed6129 Linneal Beach Drive
CityStateZip CodeCounty
ApopkaFL32703Seminole
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
H00218$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME63259Emergency Medicine - Including Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SOUTH LAKE HOSPITAL100051
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
6/2/20016/11/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Complaints of headache, shoulder & neck pain, fever & vomiting.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Treatment for otitis media, cervical pain & functional stress headache.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose Pseudotumor Cerebri.
Principal Injury Giving Rise To The Claim
Permanent blindness.
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
10/30/200303CA3561
County Suit Filed inDate of Final Disposition
Lake4/18/2006
Other Defendants Involved in this Claim
Emergency Physicians of Central Florida
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
4/18/2006
 
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$44,347
All Other Loss Adjustment Expense Paid$19,033
Injured Person's Total Non-Economic Loss$0
Deductible$100,000
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$355,171
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
n/a
 
Updates
 
 
Date of Change:2/3/2009 3:29:10 PM
Reason for Change:Update to legal fees & expenses paid.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel3054444347
All Other Loss Adjustment Expense Paid2773619033

 

 

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Dr. Miguel Bryce Medical Malpractice Lawsuits - Court Case # 05-CA-1212

Indemnity Paid: $1,000,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200747555
Claim Number :21299
Date Submitted :12/12/2007
 
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
IndividualMiguel Bryce
Insurer TypeStreet Address of Practice
Licensed1879 Nightingale Lane
CityStateZip CodeCounty
TavaresFL32778Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600095 05$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME84628Surgery - Cardiovascular Disease73701

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLORIDA HOSPITAL WATERMAN100057
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
3/26/20031/3/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Sinus bradycardia with sinus arrest and ventricular escape rhythm
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Implant dual chamber pacemaker
Diagnostic Code :353.8
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged improper placement of pacemaker lead
Principal Injury Giving Rise To The Claim
Stroke, hemiplegia, speech impairment, memory loss
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
4/25/200505-CA-1212
County Suit Filed inDate of Final Disposition
Lake11/26/2007
Other Defendants Involved in this Claim
Cardiovascular Associates of Lake County
Cardiovascular Associates of Central Florida
Medtronics, Inc.
Cacodcar, MD, Surexa S
Drummond, Douglas
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
10/30/2007
 
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$92,672
All Other Loss Adjustment Expense Paid$31,704
Injured Person's Total Non-Economic Loss$1,000,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$150,000$0
Wage Loss$0$754,000
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:12/12/2007 1:07:49 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 11/26/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition18-OCT-0726-NOV-07

 

 

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Dr. Srinivas Attanti Medical Malpractice Lawsuits - Court Case # 10-CA-1480

Indemnity Paid: $1,000,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201159557
Claim Number :30701/32360
Date Submitted :3/25/2011
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualSrinivas Attanti
Insurer TypeStreet Address of Practice
Licensed308 W. Highland Blvd.
CityStateZip CodeCounty
InvernessFL34452Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1602338 01$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME90705Internal Medicine - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Special Procedure Room 
Date of OccurrenceDate Reported to Insurer
12/3/20076/10/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Carotid artery
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Doppler study
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform and interpret carotid artery Doppler study
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.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/19/201010-CA-1480
County Suit Filed inDate of Final Disposition
Lake2/3/2011
Other Defendants Involved in this Claim
Hinkle, Ken
Citrus Cardiology Consultants, 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 not subject to Arbitration.
Date of Payment
1/6/2011
 
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$23,178
All Other Loss Adjustment Expense Paid$9,884
Injured Person's Total Non-Economic Loss$800,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$124,328$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:3/25/2011 2:38:28 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 02/03/11
 
Field ChangedFormer ValueNew Value
Date of Final Disposition06-JAN-1103-FEB-11

 

 

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Dr. Todd Ginestra Medical Malpractice Lawsuits - Court Case # 13-CA-3156

Indemnity Paid: $875,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201574384
Claim Number : 7030062378
Date Submitted : 4/23/2015
 
Insurer Information
 
Insurer Name Coverage Type
LANDMARK AMERICAN INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
73-0994137  
Insurer Contact Information
Type First Name MI Last Name
Individual Jim   Dapolite
Street Address
945 East Paces Ferry Rd, Suite 1800
City State Zip
Atlanta GA 30326
Phone Ext Fax E-Mail Address
(404) 682 - 7683   (404) 262 - 4437 jdapolite@rsui.com
 
Insured Information
 
Type First Name MI Last Name
Individual Todd   Ginestra
Insurer Type Street Address of Practice
Licensed 757 CR 466
City State Zip Code County
Lady Lake FL 32159 Lake
Policy Number Per Claim Policy Limits Aggregate Policy Limits
LHM735011 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME110377 Surgery - Plastic  

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 Lake
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
1/29/2013 2/8/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient presented for elective ADN cosmetic liposuction surgery to her abdomen, neck, and jowls.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The insured performed a liposuction procedure known as Smartlipo to the patients abdomen, neck, and jowls.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
The patient alleges that the physician failed to administer preoperative or post-operative antibiotics, resulting in development of an abdominal infection. The patient additionally alleges the physician failed to properly assess or treat the patient post operatively.
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
3/7/2014 13-CA-3156
County Suit Filed in Date of Final Disposition
Lake 4/9/2015
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
 
 
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 $124,978
Injured Person's Total Non-Economic Loss $0
Deductible $5,000
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
Not known.
 
Updates
 
No updates found.

 

 

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

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Dr. Nicholai Zelneronok Medical Malpractice Lawsuits - Court Case # 2013-CA-002314

Indemnity Paid: $800,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201470505
Claim Number :43575
Date Submitted :7/11/2014
 
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
IndividualNicholai Zelneronok
Insurer TypeStreet Address of Practice
Licensed13 Sanchez Avenue
CityStateZip CodeCounty
Saint AugustineFL32084St. Johns
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PRF 1411245 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME34231Surgery - Urological 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MSt. Johns
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
2/3/20111/7/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Lung cancer
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 pre-procedure chest x-ray
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
7/31/20132013-CA-002314
County Suit Filed inDate of Final Disposition
Lake5/19/2014
Other Defendants Involved in this Claim
Central Florida Urology Specialists
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
4/3/2014
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$800,000
Loss Adjust Expense Paid to Defense Counsel$19,399
All Other Loss Adjustment Expense Paid$10,970
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$0$50,000
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:7/11/2014 10:51:16 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 05/19/14
 
Field ChangedFormer ValueNew Value
Date of Final Disposition03-APR-1419-MAY-14

 

 

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Dr. Eze D Uche Medical Malpractice Lawsuits - Court Case # 2014-CP-00040

Indemnity Paid: $750,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201573528
Claim Number : 47975
Date Submitted : 3/27/2015
 
Insurer Information
 
Insurer Name Coverage Type
MAG MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
58-1449198  
Insurer Contact Information
Type Entity Name
Entity MAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
City State Zip
Orlando FL 32819
Phone Ext Fax E-Mail Address
(407) 370 - 3813   (407) 370 - 2247 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Eze D Uche
Insurer Type Street Address of Practice
Licensed 1020 N. Blvd. E.
City State Zip Code County
Leesburg FL 34748 Lake
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1601962 08 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME73420 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 Lake
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
1/23/2013 3/20/2014
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Right heart failure and aortic stenosis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat incompetent artifical mitral and aortic valves
Principal Injury Giving Rise To The Claim
Right heart failure and aortic stenosis
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
8/26/2014 2014-CP-00040
County Suit Filed in Date of Final Disposition
Lake 3/17/2015
Other Defendants Involved in this Claim
Cardiovascular Institute PA
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
2/10/2015
 
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 $14,141
All Other Loss Adjustment Expense Paid $14,738
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 $15,477 $50,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change: 3/27/2015 11:15:49 AM
Reason for Change: Report updated to reflect Court Document final disposition date of 3/17/15
 
Field Changed Former Value New Value
Date of Final Disposition 10-FEB-15 17-MAR-15

 

 

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Dr. Ivan J Wortman Medical Malpractice Lawsuits - Court Case # 03CA3561

Indemnity Paid: $750,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200640477
Claim Number :860861
Date Submitted :5/4/2006
 
Insurer Information
 
Insurer NameCoverage Type
MEDICAL PROTECTIVE COMPANY (THE)Excess
Insurer FEINProfessional License Number
35-0506406 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualPamelaAPrudlow
Street Address
5814 Reed Road
CityStateZip
Ft. WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0370 (260) 486 - 0785pamela.prudlow@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualIvanJWortman
Insurer TypeStreet Address of Practice
Licensed6129 Linneal Beach Drive
CityStateZip CodeCounty
ApopkaFL32703Seminole
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
H00219$7,000,000$7,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME63259Emergency Medicine - Including Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
SOUTH LAKE HOSPITAL100051
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
6/2/20016/11/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Complaints of headache, shoulder & neck pain, fever & vomiting.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Treatment for otitis media, cervical pain & functional stress headache.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose Pseudotumor Cerebri.
Principal Injury Giving Rise To The Claim
Permanent blindness.
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
10/30/200303CA3561
County Suit Filed inDate of Final Disposition
Lake4/18/2006
Other Defendants Involved in this Claim
Emergency Physicians of Central Florida
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
4/18/2006
 
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$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$355,171
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. Mark D Jacobson Medical Malpractice Lawsuits - Court Case # 2004-CA-366

Indemnity Paid: $750,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200746961
Claim Number :18523
Date Submitted :9/17/2007
 
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
IndividualMarkDJacobson
Insurer TypeStreet Address of Practice
Licensed801 East Dixie Avenue #104
CityStateZip CodeCounty
LeesburgFL34748Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600001 04$2,000,000$4,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME67158Radiology - Diagnostic - Minor Surgery3605

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LEESBURG REGIONAL MEDICAL CENTER100084
Location of Institutional InjuryOther Location of Institutional Injury
Critical Care Unit 
Date of OccurrenceDate Reported to Insurer
7/23/20039/16/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Right superficial femoral arterial occlusive disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Percutaneous angioplasty
Diagnostic Code :1942.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly manage patient after angioplasty
Principal Injury Giving Rise To The Claim
Petroperitoneal hematoma and extravasation
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
1/28/20042004-CA-366
County Suit Filed inDate of Final Disposition
Lake8/10/2007
Other Defendants Involved in this Claim
Paymani, MD, Mahrad
Hessami, MD, Miratiqullah
Radiology Associates of Central Florida
Central Florida Health Care Development Corp.
Leesburg Regional Medial 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
9/7/2007
 
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$101,501
All Other Loss Adjustment Expense Paid$36,134
Injured Person's Total Non-Economic Loss$750,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$70,000$0
Wage Loss$0$250,000
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. RAYMOND COLOM Medical Malpractice Lawsuits - Court Case # 11CA3441

Indemnity Paid: $700,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264452
Claim Number :472
Date Submitted :7/30/2012
 
Insurer Information
 
Insurer NameCoverage Type
COLUMBIA CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
47-0490411 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualJaclynSAdler
Street Address
9300 NW 14th Street
CityStateZip
Pembroke PinesFL33024
PhoneExtFaxE-Mail Address
(954) 559 - 3131 (954) 431 - 8388Jadjuster2@aol.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRAYMOND COLOM
Insurer TypeStreet Address of Practice
Licensed600 East Dixie Avenue
CityStateZip CodeCounty
Leesburg FL34748Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ1064385823-5$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME70197Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LEESBURG REGIONAL MEDICAL CENTER100084
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
3/19/20107/1/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
7-month old male with a history of a chromosomal deficiency, Glutaric Acidemia Type I (GA-I), was brought to the ED of Leesburg Regional Medical Center by his mother who reported vomiting since the previous day and a fever the previous day.He was discharged with diagnoses of vomiting and possible viral illness.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
There was no operation, diagnostic, or treatment procedure that caused an injury.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
There was no misdiagnosis.
Principal Injury Giving Rise To The Claim
A 7-month old male with a history of a chromosomal deficiency, Glutaric Acidemia Type I (GA-I), was brought to the ED of Leesburg Regional Medical Center by his mother who reported vomiting since the previous day and a fever the previous day. The child was seen in the ED by Raymond Colom, MD and when his shift ended, care was taken over by another physician, who discharged the patient with clinical impressions of (1) Vomiting (2) Possible Viral illness.The following day, the child was seen at another hospital with lethargy and hypotonia.He was then transferred to a tertiary children's hospital for treatment. There he was additionally diagnosed with encephalopathy and seizures.He was discharged on 3/24/10.The child suffered damage to the basil ganglia of his brain resulting in severe developmental delays.It was alleged that these damages were due to delays in treatment of the GA-1. There was a dispute over whether or not the patient's mother providedDr. Colom (and the physician who saw the child after Dr. Colom went off-duty) with an "Emergency Medical Protocol" form that explained the child's GA-1 condition and the treatment protocols that were required for him.The claim was disputed.A compromise settlement was reached without admission of liability.
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
12/16/201111CA3441
County Suit Filed inDate of Final Disposition
Lake7/19/2012
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/19/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$700,000
Loss Adjust Expense Paid to Defense Counsel$5,614
All Other Loss Adjustment Expense Paid$2,122
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. Yin Luk Medical Malpractice Lawsuits - Court Case # 2013-CA-001734

Indemnity Paid: $700,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201369238
Claim Number :301662
Date Submitted :12/18/2013
 
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
IndividualYin Luk
Insurer TypeStreet Address of Practice
Licensed601 East Dixie Avenue Suite 801
CityStateZip CodeCounty
LeesburgFL34748Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0615277$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME101492Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
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
Operating Suite 
Date of OccurrenceDate Reported to Insurer
11/11/201112/20/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient underwenta cholesystectomy.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged injury to patient's bile duct system during cholesystectomy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged injury to patient's bile duct system during cholesystectomy.
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
6/4/20132013-CA-001734
County Suit Filed inDate of Final Disposition
Lake12/11/2013
Other Defendants Involved in this Claim
Leesburg 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
OtherVoluntary Dismissal
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/6/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$700,000
Loss Adjust Expense Paid to Defense Counsel$27,000
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$600,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown
 
Updates
 
No updates found.

 

 

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

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Dr. Helene M Aisenstat Medical Malpractice Lawsuits - Court Case # 2016-CA-000849A

Indemnity Paid: $625,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201781444
Claim Number : 1030710
Date Submitted : 8/22/2017
 
Insurer Information
 
Insurer Name Coverage Type
MEDICAL PROTECTIVE COMPANY (THE) Primary
Insurer FEIN Professional License Number
35-0506406  
Insurer Contact Information
Type First Name MI Last Name
Individual Lynn Louthan
Street Address
5814 Reed Road
City State Zip
Ft Wayne IN 46835
Phone Ext Fax E-Mail Address
(260) 486 - 0778     reportaclaim@medpro.com
 
Insured Information
 
Type First Name MI Last Name
Individual Helene M Aisenstat
Insurer Type Street Address of Practice
Licensed 280 Farner PL
City State Zip Code County
The Villages FL 32163 Sumter
Policy Number Per Claim Policy Limits Aggregate Policy Limits
774582 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME116437 Family Physicians or General Practitioners - 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 Sumter
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
3/17/2015 1/18/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Cough, mucus, pain in esophagus from coughing
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
EKG, nitrostat, follow up with cardiologist within one week
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
failure to recognize symptoms of acute coronary syndrome and transfer to ER for cardiac work up
Principal Injury Giving Rise To The Claim
heart attack and 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
5/10/2016 2016-CA-000849A
County Suit Filed in Date of Final Disposition
Lake 2/27/2017
Other Defendants Involved in this Claim
The Villages Health System 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
Other Settled before trial
Arbitration
Claim not subject to Arbitration.
Date of Payment
2/27/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $625,000
Loss Adjust Expense Paid to Defense Counsel $11,183
All Other Loss Adjustment Expense Paid $1,266
Injured Person's Total Non-Economic Loss $117,200
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
n/a
 
Updates
 
 
Date of Change: 8/22/2017 4:03:46 PM
Reason for Change: ALE UPDATE 8/22/2017
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 6413 11183
All Other Loss Adjustment Expense Paid 666 1266

 

 

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Dr. Robert A Honegger Medical Malpractice Lawsuits - Court Case # 2010-CA-004925

Indemnity Paid: $607,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161615
Claim Number :273
Date Submitted :9/14/2011
 
Insurer Information
 
Insurer NameCoverage Type
COLUMBIA CASUALTY COMPANYPrimary
Insurer FEINProfessional License Number
47-0490411 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualJaclynSAdler
Street Address
9300 NW 14th Street
CityStateZip
Pembroke PinesFL33024
PhoneExtFaxE-Mail Address
(954) 559 - 3131 (954) 431 - 8388Jadjuster2@aol.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRobertAHonegger
Insurer TypeStreet Address of Practice
Licensed600 E. Dixie Avenue
CityStateZip CodeCounty
LeesburgFL34748Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HAZ1064385823-4$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME46950Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LEESBURG REGIONAL MEDICAL CENTER100084
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
6/25/20086/22/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The final diagnosis was a benign tumor at the T9 vertebral level with cord compression. (The patient presented with varying complaints of low back pain, abdominal pain, weak and buckling legs, and constipation.)
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
There was no operation, diagnostic, or treatment procedure rendered that caused an injury.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
The patient was diagnosed with left leg sciatica with numbness.
Principal Injury Giving Rise To The Claim
The patient is now paraplegic.
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
10/28/20102010-CA-004925
County Suit Filed inDate of Final Disposition
Lake9/1/2011
Other Defendants Involved in this Claim
Leesburg Regional Medical Center
Florida Emergency Physicians Kang & Assoc.
Rivera, Alberto R
Florida Waterman 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
9/1/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$607,500
Loss Adjust Expense Paid to Defense Counsel$20,161,000
All Other Loss Adjustment Expense Paid$3,147,000
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. DANIEL W WHINNEN Medical Malpractice Lawsuits - Court Case # 2014-CA-000184

Indemnity Paid: $550,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201676983
Claim Number : 1016695-01
Date Submitted : 8/11/2016
 
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 DANIEL W WHINNEN
Insurer Type Street Address of Practice
Licensed 5051 SE 110th Street
City State Zip Code County
Belleview FL 34420 Marion
Policy Number Per Claim Policy Limits Aggregate Policy Limits
767545 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME83669 Family Physicians or General Practitioners - 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 Marion
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
4/1/2013 11/26/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hematuria (blood in urine)
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Treated as UTI
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to timely diagnose bladder cancer
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
2/20/2014 2014-CA-000184
County Suit Filed in Date of Final Disposition
Lake 1/29/2016
Other Defendants Involved in this Claim
McQuade MD, Colleen
The Family Doctors of Belleview
Bonen Clark PA, Susan E
Kinsey PA, Jamie R
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
1/28/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $550,000
Loss Adjust Expense Paid to Defense Counsel $32,634
All Other Loss Adjustment Expense Paid $14,036
Injured Person's Total Non-Economic Loss $396,000
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 9:59:57 AM
Reason for Change: ALE UPDATED 8/11/2016
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 29706 32634
All Other Loss Adjustment Expense Paid 11985 14036

 

 

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Dr. Jamie R Kinsey Medical Malpractice Lawsuits - Court Case # 2014-CA-000184

Indemnity Paid: $550,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201676984
Claim Number : 1016695-04
Date Submitted : 8/11/2016
 
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 Jamie R Kinsey
Insurer Type Street Address of Practice
Licensed 8075 SW 15th Court
City State Zip Code County
Ocala FL 34470 Marion
Policy Number Per Claim Policy Limits Aggregate Policy Limits
C53812 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Other Physician Assistant
License Number Specialty Code & Classification Certification Number
PA9106162    

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 Marion
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
4/1/2013 11/26/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hematuria (blood in urine)
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Treated as UTI
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to timely diagnose bladder cancer
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
2/20/2014 2014-CA-000184
County Suit Filed in Date of Final Disposition
Lake 1/29/2016
Other Defendants Involved in this Claim
McQuade MD, Colleen
Whinnen MD, Daniel W
The Family Doctors of Belleview
Bonen Clark PA, Susan E
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
1/28/2016
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $550,000
Loss Adjust Expense Paid to Defense Counsel $15,678
All Other Loss Adjustment Expense Paid $6,560
Injured Person's Total Non-Economic Loss $396,000
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 10:01:28 AM
Reason for Change: ALE UPDATED 8/11/2016
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 13984 15678
All Other Loss Adjustment Expense Paid 5096 6560

 

 

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Dr. Fouad Shami Medical Malpractice Lawsuits - Court Case # 2010-CA-000023

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201160818
Claim Number :09-08-0173-A
Date Submitted :6/15/2011
 
Insurer Information
 
Insurer NameCoverage Type
FD INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
20-3704679 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualLinda Collins
Street Address
4655 Salisbury Road, Suite 110
CityStateZip
JacksonvilleFL32256
PhoneExtFaxE-Mail Address
(904) 296 - 2887214(904) 296 - 8919lcollins@fldic.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualFouad Shami
Insurer TypeStreet Address of Practice
Licensed1901 SE 18th Avenue #300
CityStateZip CodeCounty
OcalaFL34471Marion
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MG000585$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME20978Surgery - Urological 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LEESBURG REGIONAL MEDICAL CENTER100084
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
1/12/200811/3/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented to the ER complaining of nausea, chills, vomiting and right flank pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Labs and CT scan.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat patient's true condition.
Principal Injury Giving Rise To The Claim
Loss of fingers and toes due to sepsis.
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
2/8/20102010-CA-000023
County Suit Filed inDate of Final Disposition
Lake5/24/2011
Other Defendants Involved in this Claim
Reddy, M.D., Movva
Leesburg Regional Medical Center
Simons, PA-C, Amy
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
5/6/2011
 
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$59,921
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 the case with the Insured.
 
Updates
 
No updates found.

 

 

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Dr. JUDITH MILSTEAD Medical Malpractice Lawsuits - Court Case # 99-1204CA

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200537941
Claim Number :98-0277
Date Submitted :11/3/2005
 
Insurer Information
 
Insurer NameCoverage Type
CLARENDON NATIONAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
52-0266645 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualKim Cote
Street Address
2000 W. Sam Houston Parkway South
CityStateZip
HoustonTX77042
PhoneExtFaxE-Mail Address
(713) 722 - 16481648(713) 243 - 7311kim_cote@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJUDITH MILSTEAD
Insurer TypeStreet Address of Practice
Licensed601 E DIXIE AVE
CityStateZip CodeCounty
LEESBURGFL34748-5953Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMP0005854$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME41306Otorhinolaryngology - No Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
LEESBURG REGIONAL MEDICAL CENTER100084
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
5/27/19971/22/1999
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
DIAGNOSED W/CHRONIC SINUSITIS & NASAL SEPTAL DEVIATION; CT SCAN SHOWED BILATERAL OSTEOMEATAL COMPLEX DISEASE & HYPERTROPHIC INFERIOR TURBINATE.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
DOCTOR PERFORMED AN ANTERIOR ETHMOIDECTOMIES W/ANTROSTOMIES; SEPTOPLASTY & BILATERAL PARTIAL RESECTION OF INFERIOR TURBINATES.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
NO MISDIAGNOSIS
Principal Injury Giving Rise To The Claim
ALLEGED FAILURE TO PROPERLY MANAGE PATIENT'S HYPOXIA; DELAYED ADEQUATE MECHANICAL VENTILATION & INSUFFICIENT POST-OP CARE
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
5/19/199999-1204CA
County Suit Filed inDate of Final Disposition
Lake10/3/2002
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
 
 
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$106,248
All Other Loss Adjustment Expense Paid$7,813
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. Jeffrey D Baumann Medical Malpractice Lawsuits - Court Case # 12-CA-2746

Indemnity Paid: $475,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367631
Claim Number :5149108-01
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
IndividualSusanKSpielman
Street Address
5814 Reed Road
CityStateZip
Fort WayneIN46835
PhoneExtFaxE-Mail Address
(260) 486 - 0340  reportaclaim@medpro.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJeffreyDBaumann
Insurer TypeStreet Address of Practice
Licensed12 South Park Ave
CityStateZip CodeCounty
ApopkaFL32703Orange
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
716981$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME45010Surgery - Opthalmology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
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
10/8/20084/10/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Nevus right eye
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Exam
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose ocular melanoma
Principal Injury Giving Rise To The Claim
Metastasis resulting in death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/13/201212-CA-2746
County Suit Filed inDate of Final Disposition
Lake6/17/2013
Other Defendants Involved in this Claim
Mid-Florida Eye Center PA
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/17/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$475,000
Loss Adjust Expense Paid to Defense Counsel$3,621
All Other Loss Adjustment Expense Paid$1,015
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
N/A
 
Updates
 
 
Date of Change:9/23/2013 3:45:38 PM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel20113621
All Other Loss Adjustment Expense Paid7751015

 

 

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Dr. Jeffrey D Baumann Medical Malpractice Lawsuits - Court Case # 12-CA-2746

Indemnity Paid: $475,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367632
Claim Number :5149108-01
Date Submitted :1/27/2014
 
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
IndividualJeffreyDBaumann
Insurer TypeStreet Address of Practice
Licensed12 South Park Ave
CityStateZip CodeCounty
ApopkaFL32703Orange
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
716981$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME45010Surgery - Opthalmology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FLake
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
10/8/20084/10/2012
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Nevus right eye
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Exam
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose ocular melanoma
Principal Injury Giving Rise To The Claim
Metastasis resulting in death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
8/13/201212-CA-2746
County Suit Filed inDate of Final Disposition
Lake6/17/2013
Other Defendants Involved in this Claim
Mid-Florida Eye Center PA
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/17/2013
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$475,000
Loss Adjust Expense Paid to Defense Counsel$5,274
All Other Loss Adjustment Expense Paid$1,612
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
N/A
 
Updates
 
 
Date of Change:1/27/2014 4:16:52 PM
Reason for Change:ALE UPDATE
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel20115274
All Other Loss Adjustment Expense Paid7751612

 

 

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Dr. PHILLIP DASCHER Medical Malpractice Lawsuits - Court Case # 2003CA1594

Indemnity Paid: $450,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200433217
Claim Number :19371-01
Date Submitted :5/11/2007
 
Insurer Information
 
Insurer NameCoverage Type
AMERICAN PHYSICIANS ASSURANCE CORPORATIONPrimary
Insurer FEINProfessional License Number
38-2102867 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualChristine Sampson
Street Address
200 East Gaines Street
CityStateZip
TallahasseeFL32399
PhoneExtFaxE-Mail Address
(850) 413 - 5358 (850) 921 - 8243Christine.Sampson@fldfs.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualPHILLIP DASCHER
Insurer TypeStreet Address of Practice
Licensed720 N BAY ST
CityStateZip CodeCounty
EUSTISFL32726-2964Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
125720$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME32039Surgery - GeneralN/A

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FLORIDA HOSPITAL WATERMAN100057
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/12/200112/5/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
PATIENT HAD INFLAMED SEVERE ACUTE CHOLECYSTITIS AND CHOLELITHIASIS.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
INSURED PERFORMED A LAPAROSCOPIC CHOLECSYTECTOMY.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
BILE LEAKAGE WHICH REQUIRED EXTENSIVE RECONSTRUCTIVE SURGERY.
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
5/16/20032003CA1594
County Suit Filed inDate of Final Disposition
Lake10/26/2004
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
10/14/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$450,000
Loss Adjust Expense Paid to Defense Counsel$0
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$450,000
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 CONSULTED WITH DEFENSE COUNSEL AND CLAIMS PERSONNEL REGARDING THIS MATTER.
 
Updates
 
 
Date of Change:10/19/2005 11:13:38 AM
Reason for Change:made minor changes.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel037844
All Other Loss Adjustment Expense Paid018121
 
Date of Change:5/11/2007 2:43:30 PM
Reason for Change:OIR updating Historical Closed Claim data.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel378440
Portal User Namesteffanie simonChristine Sampson
All Other Loss Adjustment Expense Paid181210

 

 

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Dr. Bosede A Afolabi Medical Malpractice Lawsuits - Court Case # 35-2017-CA-000839

Indemnity Paid: $450,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201783760
Claim Number : 60417
Date Submitted : 12/4/2017
 
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   (404) 842 - 3319 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Bosede A Afolabi
Insurer Type Street Address of Practice
Licensed 511 Medical Plaza Dr., Ste. 101
City State Zip Code County
Leesburg FL 34748 Lake
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1602418 08 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME101618 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
  M Lake
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
4/26/2016 12/27/2016
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Aortic disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged negligent discontinuation of Eliquis
Principal Injury Giving Rise To The Claim
CVA
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
5/10/2017 35-2017-CA-000839
County Suit Filed in Date of Final Disposition
Lake 11/20/2017
Other Defendants Involved in this Claim
Florida Heart & Vascular Multi-Specialty Group
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
11/20/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $450,000
Loss Adjust Expense Paid to Defense Counsel $27,875
All Other Loss Adjustment Expense Paid $5,906
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $108,000 $0
Wage Loss $150,000 $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. Minta S Tauer Medical Malpractice Lawsuits - Court Case # 03CA2821

Indemnity Paid: $435,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200642819
Claim Number :40-009207
Date Submitted :10/20/2006
 
Insurer Information
 
Insurer NameCoverage Type
TRUCK INSURANCE EXCHANGEPrimary
Insurer FEINProfessional License Number
95-2575892 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualRichardAJones
Street Address
4680 Wilshire Blvd., 6th Floor
CityStateZip
Los AngelesCA90010
PhoneExtFaxE-Mail Address
(714) 633 - 8331 (714) 633 - 1226rich.jones@farmersinsurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualMintaSTauer
Insurer TypeStreet Address of Practice
Licensed1983 Morritts Court
CityStateZip CodeCounty
EustisFL32726Lake
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0117776130000$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Osteopathic Physician 
License NumberSpecialty Code & ClassificationCertification Number
OS5869Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MLake
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
LEESBURG REGIONAL MEDICAL CENTER100084
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
8/20/200211/27/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presents with a history of multiple wasp stings and small laceration to the occipatal region of the head.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Treatment for the wasp stings and instructions on discharge.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to obtain a CT and failure to diagnose an epidural bleed and a frontal hematoma.
Principal Injury Giving Rise To The Claim
Neurologicial damage .
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
8/26/200303CA2821
County Suit Filed inDate of Final Disposition
Lake9/26/2006
Other Defendants Involved in this Claim
Leesburg 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
10/19/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$435,000
Loss Adjust Expense Paid to Defense Counsel$3,603
All Other Loss Adjustment Expense Paid$6,057
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$116,000$0
Wage Loss$54,000$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insured does not purchase risk management services.
 
Updates
 
No updates found.

 

 

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Dr. Sanjeev Bhatta Medical Malpractice Lawsuits - Court Case # 35-2016-CA-001190

Indemnity Paid: $375,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782644
Claim Number : 52656
Date Submitted : 8/11/2017
 
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 Sanjeev   Bhatta
Insurer Type Street Address of Practice
Licensed 803 E. Dixie Ave.
City State Zip Code County
Leesburg FL 34748 Lake
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1603152 00 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME82971 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 Lake
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Outpatient Facility Lake Cardiovascular Diagnostic Center
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
10/1/2014 3/16/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Renal stenosis, hypertension
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Balloon angioplasty and stent placement
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged negligent performance of renal stenting
Principal Injury Giving Rise To The Claim
Arterial perforation and bleed
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
7/1/2016 35-2016-CA-001190
County Suit Filed in Date of Final Disposition
Lake 8/1/2017
Other Defendants Involved in this Claim
Yelamanchi, MD, Vishnu
Moinuddin, MD, Sayeed
Villages Regional Hospital
Khadka, MD, Deepali
Cardiac Specialty Institute
Physicians of Central Florida
Cardiac and Vascular Consultants
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
7/5/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $375,000
Loss Adjust Expense Paid to Defense Counsel $41,966
All Other Loss Adjustment Expense Paid $22,513
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 $100,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change: 8/11/2017 11:55:27 AM
Reason for Change: Report updated to reflect Court Document final disposition date of 08/01/17
 
Field Changed Former Value New Value
Date of Final Disposition 05-JUL-17 01-AUG-17

 

 

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Dr. Deepali Khadka Medical Malpractice Lawsuits - Court Case # 2016-CA-001190

Indemnity Paid: $375,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782815
Claim Number : 145025
Date Submitted : 8/14/2017
 
Insurer Information
 
Insurer Name Coverage Type
MEDICUS INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
20-5623491  
Insurer Contact Information
Type First Name MI Last Name
Individual Dionysia   Lawson
Street Address
560 Davis Street
City State Zip
San Francisco CA 94111
Phone Ext Fax E-Mail Address
(415) 735 - 2013   (415) 735 - 2097 dlawson@norcalmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Deepali   Khadka
Insurer Type Street Address of Practice
Licensed 18550 US Hwy 441
City State Zip Code County
Mount Dora FL 32757 Lake
Policy Number Per Claim Policy Limits Aggregate Policy Limits
FL-16116278 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME106157 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 Lake
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Outpatient Facility Lake Cardiovascular Diagnostic Center
Name of Institution Code
N/A 000000
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
10/3/2014 8/3/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
stent placement and emergency coil embolization
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
information not given at the time of report
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Estate of 84-year-old female, with extensive history of vascular disease and carotid disease alleged a delay in addressing unseuker status of her leg. Surgery to restore flow was successful. The patient suffered a stroke 3 days post operatively. The family decided to make her DNR. Treaturs opined she would have survived her stroke. The leg was not the cause of death. No documentation related delay in leg surgery to the stroke or 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
7/1/2016 2016-CA-001190
County Suit Filed in Date of Final Disposition
Lake 7/17/2017
Other Defendants Involved in this Claim
The Villages Regional Hospital
Bhatta, Sanjeev
Moinuddin, Sayed
Yelamanchi, Vishnu
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 suit before trial
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/27/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $375,000
Loss Adjust Expense Paid to Defense Counsel $27,542
All Other Loss Adjustment Expense Paid $10,473
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
Insured conferenced with defense attorney and claims specialist
 
Updates
 
No updates found.

 

 

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

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Dr. ARIF U REHMAN Medical Malpractice Lawsuits - Court Case # 2017-CA-001072

Indemnity Paid: $350,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201886671
Claim Number : EHC-FL-17XS-394651
Date Submitted : 10/10/2018
 
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 ARIF U REHMAN
Insurer Type Street Address of Practice
Self-Insurer 13737 NOEL RD., STE. 1600
City State Zip Code County
DALLAS TX 75240 Out of state
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HAZ 1040025381-15 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME83632 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 Lake
City State Zip Code
     
Location where injury occured Other location where injury occured
Emergency Room  
Name of Institution Code
LEESBURG REGIONAL MEDICAL CENTER 100084
Location of Institutional Injury Other Location of Institutional Injury
Other ER
Date of Occurrence Date Reported to Insurer
4/2/2015 4/12/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
BRAIN HEMORRHAGE
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 TREAT
Principal Injury Giving Rise To The Claim
BRAIN HEMORRHAGE AND 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
10/2/2017 2017-CA-001072
County Suit Filed in Date of Final Disposition
Lake 10/10/2018
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
9/11/2018
 
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 $43,293
All Other Loss Adjustment Expense Paid $7,647
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. Roger E Bassin Medical Malpractice Lawsuits - Court Case # 2010CA004840

Indemnity Paid: $350,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161805
Claim Number :7382
Date Submitted :10/7/2011
 
Insurer Information
 
Insurer NameCoverage Type
OPHTHALMIC MUTUAL INSURANCE COMPANY (A R.R.G.)Primary
Insurer FEINProfessional License Number
94-3047990 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualRogerEBassin
Street Address
1705 Berglund Lane, Suite 103
CityStateZip
VieraFL32940
PhoneExtFaxE-Mail Address
(321) 255 - 0025 (321) 255 - 0027christine@drbassin.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRogerEBassin
Insurer TypeStreet Address of Practice
Licensed1705 Berglund Lane, Suite 103
CityStateZip CodeCounty
VieraFL32940Brevard
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
OMC0009888$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME85585Surgery - Opthalmology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOrange
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
Operating Suite 
Date of OccurrenceDate Reported to Insurer
4/14/20107/15/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
pt was diagnosed with having retrobulbar hematoma
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
patient had facelift and blepharplasty
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
pt was diagnosed with having retrobulbar hematoma
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
12/1/20102010CA004840
County Suit Filed inDate of Final Disposition
Lake5/5/2011
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
5/5/2011
 
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$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
Office is in contact with patients the evening of their procedure for follow-up care in addition tonext day for post surgical followup. Continuing to provide additional patient instruction to patients prior to surgery on awareness of post surgical complications.
 
Updates
 
No updates found.

 

 

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

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