Medical Malpractice Cases

Medical Malpractice Cases In Okaloosa County Florida

Dr. Claben Rey Barraca Medical Malpractice Lawsuits - Court Case # 2016-CA-001027F

Indemnity Paid: $1,000,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782234
Claim Number : 155400-2
Date Submitted : 4/13/2018
 
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 Claben Rey   Barraca
Insurer Type Street Address of Practice
Licensed 100 Mar-Walt Drive
City State Zip Code County
Fort Walton Beach FL 32547 Okaloosa
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HCI-10113 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME92836 Psychiatry - All Other 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 Okaloosa
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
FORT WALTON BEACH MEDICAL CENTER 100223
Location of Institutional Injury Other Location of Institutional Injury
Patients' Room  
Date of Occurrence Date Reported to Insurer
8/30/2013 6/10/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Postpartum depression, anxiety, suicide attempt.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Allege patient was prematurely discharged & sent home with a prescription for too high a dose of Ambien, along with allegations that physician failed to properly assess & treat patient for suicidal ideation brought on by postpartum depression.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Suicide.
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of Suit Circuit Court Case Number
3/23/2016 2016-CA-001027F
County Suit Filed in Date of Final Disposition
Okaloosa 5/18/2017
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
5/4/2017
 
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 $201,505
All Other Loss Adjustment Expense Paid $53,873
Injured Person's Total Non-Economic Loss $925,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $0 $0
Wage Loss $0 $0
Other Expenses $0 $150,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Review of policies and procedures.
 
Updates
 
 
Date of Change: 4/13/2018 9:55:30 AM
Reason for Change: Additional LAE payments made.
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 140791 201505
All Other Loss Adjustment Expense Paid 26014 53873

 

 

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

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Dr. John F Huhn Medical Malpractice Lawsuits - Court Case # 03CA8384

Indemnity Paid: $850,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432146
Claim Number :00-16521
Date Submitted :7/26/2004
 
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
2000 West Sam Houston Parkway South, 19th Floor; One Briarlake Plaza
CityStateZip
HoustonTX77042-361
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJohnFHuhn
Insurer TypeStreet Address of Practice
Licensed7251 University Blvd.Suite 300
CityStateZip CodeCounty
Winter ParkFL32792Orange
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMP0005832$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME61564Surgery - Laryngology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOrange
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
4/11/20019/7/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Large mass involving sphenoid sinus in the surrounding structures
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Bilateral endoscopicsphenoidotomy on outpatient basis
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
Alleged that upon awakening from procedure, the patient complained of vision loss in left eye and very shortly thereafter, total 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
9/23/200303CA8384
County Suit Filed inDate of Final Disposition
Okaloosa6/28/2004
Other Defendants Involved in this Claim
Montoya, German
Florida Otolaryngology Group, PA
Orlando Neurosurgical Associates, P.A.
German Montoya, 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 not subject to Arbitration.
Date of Payment
7/14/2004
 
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$18,240
All Other Loss Adjustment Expense Paid$5,205
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. David W Burkland Medical Malpractice Lawsuits - Court Case # 2003 CA 003661 S

Indemnity Paid: $725,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432386
Claim Number :17606
Date Submitted :8/5/2004
 
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  cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDavidWBurkland
Insurer TypeStreet Address of Practice
Licensed1005 MAR WALT DR
CityStateZip CodeCounty
FORT WALTON BEACHFL32547-6707Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
FL 15715Physicians - Minor Surgery.NOC classification.330368503

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/2/20014/22/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Suspected primary splenic lymphoma
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Splenectomy
Diagnostic Code :571.5
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose cirrhosis and portal hypertension
Principal Injury Giving Rise To The Claim
Bleeding
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/12/20032003 CA 003661 S
County Suit Filed inDate of Final Disposition
Okaloosa8/5/2004
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
8/5/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$725,000
Loss Adjust Expense Paid to Defense Counsel$32,813
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$725,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$6,000$900,000
Other Expenses$2,000$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. Wayne E Campbell Medical Malpractice Lawsuits - Court Case # 04-CA-1786-C-JT

Indemnity Paid: $650,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200639933
Claim Number :18846
Date Submitted :3/16/2006
 
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
IndividualWayneECampbell
Insurer TypeStreet Address of Practice
Licensed550 REDSTONE AVE W STE 200
CityStateZip CodeCounty
CRESTVIEWFL32536-6429Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600515 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME30203Internal Medicine - No Surgery1103

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Outpatient FacilityCampbell Crestview Medical Clinic
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
5/19/200210/21/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Intermittent chest pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
EKG, prescribed Bextra
Diagnostic Code :428.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to hospitalize 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
4/27/200404-CA-1786-C-JT
County Suit Filed inDate of Final Disposition
Okaloosa2/17/2006
Other Defendants Involved in this Claim
Crestview Medical Clinic, 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
2/28/2006
 
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$10,902
All Other Loss Adjustment Expense Paid$11,532
Injured Person's Total Non-Economic Loss$650,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$4,975$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. Joseph A Pedone Medical Malpractice Lawsuits - Court Case # 13-003278-CA

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201573845
Claim Number : 43987
Date Submitted : 5/4/2015
 
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 Joseph A Pedone
Insurer Type Street Address of Practice
Licensed 129 E. Redstone Ave. Ste. A
City State Zip Code County
Crestview FL 32539 Okaloosa
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 1601320 08 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME82012 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 Okaloosa
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
FORT WALTON BEACH MEDICAL CENTER 100223
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
12/20/2010 12/15/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Single vessel disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Placement of MYNX closure device
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform procedure
Principal Injury Giving Rise To The Claim
Occlusion and left leg injury
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
7/17/2013 13-003278-CA
County Suit Filed in Date of Final Disposition
Okaloosa 4/23/2015
Other Defendants Involved in this Claim
Zarate, MD, Juan C
Okaloosa Cardiology
Ft. Walton Beach Medical Center
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/16/2015
 
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 $30,773
All Other Loss Adjustment Expense Paid $8,239
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $1,351,994 $2,554,980
Wage Loss $0 $181,000
Other Expenses $0 $17,552
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change: 5/4/2015 1:16:14 PM
Reason for Change: Report updated to reflect 4/23/15
 
Field Changed Former Value New Value
Date of Final Disposition 16-MAR-15 23-APR-15

 

 

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Dr. Gilberto L Vigo Medical Malpractice Lawsuits - Court Case # pre-suit1

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201678058
Claim Number : 209228
Date Submitted : 10/29/2018
 
Insurer Information
 
Insurer Name Coverage Type
PROASSURANCE INDEMNITY COMPANY, INC. Primary
Insurer FEIN Professional License Number
63-0720042  
Insurer Contact Information
Type First Name MI Last Name
Individual Denise   Stokes
Street Address
100 Brookwood Place
City State Zip
Birmingham AL 35209
Phone Ext Fax E-Mail Address
(205) 802 - 4790   (205) 802 - 4710 claimscompliancereporting@proassurance.com
 
Insured Information
 
Type First Name MI Last Name
Individual Gilberto L Vigo
Insurer Type Street Address of Practice
Licensed 1005 Mar Walt Drive
City State Zip Code County
Fort Walton Beach FL 32547 Okaloosa
Policy Number Per Claim Policy Limits Aggregate Policy Limits
MP83249 $500,000 $1,500,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME65239 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 Okaloosa
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
N/A 000000
Location of Institutional Injury Other Location of Institutional Injury
Other Physican's office
Date of Occurrence Date Reported to Insurer
1/27/2014 12/16/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Intractable migraine headaches
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Medicated with prednisone
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Does not apply
Principal Injury Giving Rise To The Claim
Plaintiff alleges prescribing of chronic used steroids for treatment of migraine headaches resulted in bilateral hip necrosis, adrenal insufficiency and osteopenia.
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
1/4/2016 pre-suit1
County Suit Filed in Date of Final Disposition
Okaloosa 4/19/2016
Other Defendants Involved in this Claim
White-Wilson Medical Center, PA
Stage of Legal System at which Settlement was Reached or Award Made
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed).
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
 
 
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 $12,251
All Other Loss Adjustment Expense Paid $2,951
Injured Person's Total Non-Economic Loss $500,000
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
Insured discussed care with defense cousel, insurance personnel, and medical experts.
 
Updates
 
 
Date of Change: 5/5/2016 1:26:13 PM
Reason for Change: Updated Co-defendent info and diagnosis information.
 
Field Changed Former Value New Value
Final Diagnosis Patient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOI Intractable migraine headaches
Cause of Injury Patient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOI Medicated with prednisone
Principal Injury Patient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOI Plaintiff alleges prescribing of chronic used steroids for treatment of migraine headaches resulted in bilateral hip necrosis, adrenal insufficiency and osteopenia.
Misdiagnosis Patient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOI Does not apply
No Other Defendants 1 0
Defendant Entity Name White-Wilson Medical Center, PA
 
Date of Change: 5/12/2016 4:56:02 PM
Reason for Change: Updated indemnity amount
 
Field Changed Former Value New Value
Injured Person Total Non-Economic Loss 0 500000
Indemnity Paid 0 500000
Settlement Reached 0 1
 
Date of Change: 6/2/2016 2:57:06 PM
Reason for Change: updated ALAE amoutns
 
Field Changed Former Value New Value
All Other Loss Adjustment Expense Paid 1688 2705
Amount of Loss Adjustment Expense Paid to Defense Counsel 4455 10292
 
Date of Change: 7/8/2016 3:32:11 PM
Reason for Change: updated ALAE amounts
 
Field Changed Former Value New Value
All Other Loss Adjustment Expense Paid 2705 2712
Amount of Loss Adjustment Expense Paid to Defense Counsel 10292 10346
 
Date of Change: 2/16/2018 12:03:37 PM
Reason for Change: Updated ALAE information
 
Field Changed Former Value New Value
All Other Loss Adjustment Expense Paid 2712 2951
Amount of Loss Adjustment Expense Paid to Defense Counsel 10346 11881
 
Date of Change: 7/10/2018 1:28:21 PM
Reason for Change: updated alae
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 11881 12085
 
Date of Change: 9/26/2018 12:58:09 PM
Reason for Change: updated alae
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 12085 12187
 
Date of Change: 10/29/2018 1:17:11 PM
Reason for Change: updated alae
 
Field Changed Former Value New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel 12187 12251

 

 

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Dr. Robert L Rogers Medical Malpractice Lawsuits - Court Case # 05-CA-4249

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200851541
Claim Number :21040/21041
Date Submitted :4/1/2009
 
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
IndividualRobertLRogers
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32548Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 03$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME41071Surgery - Thoracic4812

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
12/9/200311/8/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Post-operative intraabdominal infection
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :799.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat post-operative intraabdominal infection
Principal Injury Giving Rise To The Claim
Post-operative intraabdominal infection
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/17/200505-CA-4249
County Suit Filed inDate of Final Disposition
Okaloosa3/10/2009
Other Defendants Involved in this Claim
White Wilson Medical Center
Fort Walton Beach 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
 
 
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$57,397
All Other Loss Adjustment Expense Paid$29,580
Injured Person's Total Non-Economic Loss$500,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$49,181$1,837,472
Other Expenses$66,000$2,471,938
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:4/1/2009 4:14:51 PM
Reason for Change:Report udpated to reflect Court Document final disposition date of 03/10/09
 
Field ChangedFormer ValueNew Value
Date of Final Disposition08-OCT-0810-MAR-09

 

 

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Dr. Robert L Rogers Medical Malpractice Lawsuits - Court Case # 2009-CA-0010655

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201055943
Claim Number :28753
Date Submitted :1/5/2010
 
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
IndividualRobertLRogers
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 07$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME41071Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
2/8/20073/2/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hernia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Hernia repair
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to recognize and repair small bowel perforation following hernia repair
Principal Injury Giving Rise To The Claim
Small bowel perforation
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
2/4/20092009-CA-0010655
County Suit Filed inDate of Final Disposition
Okaloosa12/23/2009
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/23/2009
 
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$16,788
All Other Loss Adjustment Expense Paid$4,569
Injured Person's Total Non-Economic Loss$133,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$330,000$0
Wage Loss$37,727$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. J E Lujan Medical Malpractice Lawsuits - Court Case # 2010-CA-0033661S

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263542
Claim Number :30415
Date Submitted :6/25/2012
 
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
IndividualJELujan
Insurer TypeStreet Address of Practice
Licensed160 E. Redstone Ave.
CityStateZip CodeCounty
CrestviewFL32539Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1601010 08$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME54171Surgery - pediatric 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
NORTH OKALOOSA MEDICAL CENTER100122
Location of Institutional InjuryOther Location of Institutional Injury
Nursery 
Date of OccurrenceDate Reported to Insurer
1/12/20095/7/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hypoglycemia
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 hypoglycemia
Principal Injury Giving Rise To The Claim
Stroke and neurologic injury/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
6/10/20102010-CA-0033661S
County Suit Filed inDate of Final Disposition
Okaloosa4/5/2012
Other Defendants Involved in this Claim
Children's Clinic
North Okaloosa Medical Center
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/5/2012
 
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$27,698
All Other Loss Adjustment Expense Paid$17,805
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$21,438$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:6/25/2012 12:36:45 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 04/05/12
 
Field ChangedFormer ValueNew Value
Date of Final Disposition05-MAR-1205-APR-12

 

 

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Dr. John C Dali Medical Malpractice Lawsuits - Court Case # 2009-CA-5206

Indemnity Paid: $475,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161503
Claim Number :27981
Date Submitted :9/1/2011
 
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
IndividualJohnCDali
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 07$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME82923Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
7/4/20088/18/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Clot in the mesenteric artery
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 SMA embolus.
Principal Injury Giving Rise To The Claim
Ischemic bowel
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/4/20092009-CA-5206
County Suit Filed inDate of Final Disposition
Okaloosa8/1/2011
Other Defendants Involved in this Claim
4MD 2-In-Patient Physician Services of Ft. Walton Beach
Boutiette, MD, Lon A
Emergency Consultants, Inc
White Wilson Medical Center
Hospital Corporation of America
Fort Walton Beach 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
8/1/2011
 
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$74,443
All Other Loss Adjustment Expense Paid$34,555
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$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. Jagannadha R Rayavarapu Medical Malpractice Lawsuits - Court Case # 06-CA-2744-C

Indemnity Paid: $450,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200746906
Claim Number :23202
Date Submitted :9/10/2007
 
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
IndividualJagannadhaRRayavarapu
Insurer TypeStreet Address of Practice
Licensed550 Redstone Ave. W. #430
CityStateZip CodeCounty
CrestviewFL32536Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600414 04$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME80138Pediatrics - Minor Surgery49511

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
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
4/2/20041/12/2006
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Group A hemolytic strep
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :730.29
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to appropriately diagnose and treat Group A hemolytic strep
Principal Injury Giving Rise To The Claim
Osteomyelitis
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
6/29/200606-CA-2744-C
County Suit Filed inDate of Final Disposition
Okaloosa7/19/2007
Other Defendants Involved in this Claim
Crestview Pediatrics & Adolescent Center
Crayton, MD, Hulon
Arthritis & Sports Care Center, 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
9/7/2007
 
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$23,237
All Other Loss Adjustment Expense Paid$22,337
Injured Person's Total Non-Economic Loss$450,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$60,000$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. WILLIAM BURDEN Medical Malpractice Lawsuits - Court Case # 002155 CA

Indemnity Paid: $450,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200747592
Claim Number :206548
Date Submitted :11/9/2007
 
Insurer Information
 
Insurer NameCoverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)Primary
Insurer FEINProfessional License Number
95-3014772 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualAngela LaFrance
Street Address
13450 W. Sunrise Blvd., Suite 160
CityStateZip
SunriseFL33323
PhoneExtFaxE-Mail Address
(954) 838 - 99886216(866) 636 - 5421alafrance@thedoctors.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualWILLIAM BURDEN
Insurer TypeStreet Address of Practice
Licensed4485 Furling Lane
CityStateZip CodeCounty
DestinFL32541Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0051443$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME64023Surgery - Plastic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
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
5/21/19971/10/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Chronic wound of the dorsum of the left foot.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Full thickness skin graft, debridement of wound and application of left ankle splint.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose postoperative infection.
Principal Injury Giving Rise To The Claim
Below the knee amputation of left leg.
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
7/22/2000002155 CA
County Suit Filed inDate of Final Disposition
Okaloosa11/8/2007
Other Defendants Involved in this Claim
Destin Plastic Surgery
Destin Orthopedic Center
Porter, M.D., Douglas
Michas, M.D., Paul A
White Wilson Medical Center, 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
10/30/2007
 
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$188,000
All Other Loss Adjustment Expense Paid$200,000
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$200,000$0
Wage Loss$0$0
Other Expenses$50,000$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown
 
Updates
 
No updates found.

 

 

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Dr. Donald E Hamilton Medical Malpractice Lawsuits - Court Case # 2018-CA-002221

Indemnity Paid: $425,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201987516
Claim Number : 61724
Date Submitted : 1/4/2019
 
Insurer Information
 
Insurer Name Coverage Type
MAG MUTUAL INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
58-1449198  
Insurer Contact Information
Type Entity Name
Entity MAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
City State Zip
Orlando FL 32819
Phone Ext Fax E-Mail Address
(407) 370 - 3813   (404) 842 - 3319 ctschanz@magmutual.com
 
Insured Information
 
Type First Name MI Last Name
Individual Donald E Hamilton
Insurer Type Street Address of Practice
Licensed 928-B Mar Walt Dr
City State Zip Code County
Fort Walton Beach FL 32547 Okaloosa
Policy Number Per Claim Policy Limits Aggregate Policy Limits
PSL 0103860 20 $500,000 $1,500,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME51415 Surgery - Otorhinolaryngology  

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 Okaloosa
City State Zip Code
     
Location where injury occured Other location where injury occured
Other Outpatient Facility Emerald Coast Surgery Center
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
7/1/2016 4/11/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Left posterior lymph node mass
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Excisional biopsy
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged unnecessary and improper performance of lymph node resection
Principal Injury Giving Rise To The Claim
Spinal accessory nerve severed; permanent injury to neck and shoulder
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
6/18/2018 2018-CA-002221
County Suit Filed in Date of Final Disposition
Okaloosa 12/3/2018
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
12/3/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $425,000
Loss Adjust Expense Paid to Defense Counsel $8,081
All Other Loss Adjustment Expense Paid $3,970
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $37,200 $0
Wage Loss $0 $0
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
No updates found.

 

Dr. Cynthia B Bryan Medical Malpractice Lawsuits - Court Case # 05-CA-2832

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200849422
Claim Number :21496
Date Submitted :8/12/2008
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualCynthiaBBryan
Insurer TypeStreet Address of Practice
Licensed1001 W. College Blvd.
CityStateZip CodeCounty
NicevilleFL32578Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600138 04$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME80397Internal Medicine - No Surgery102

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
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
3/4/20042/3/2005
 
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
No iatrogenic injury
Diagnostic Code :414.0
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to evaluate cahteterization study and act on abnormal Holter monitor study
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
4/26/200605-CA-2832
County Suit Filed inDate of Final Disposition
Okaloosa6/9/2008
Other Defendants Involved in this Claim
Powell, MD, Rodney E
Ft. Walton Beach Medical Center
Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/24/2008
 
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$37,776
All Other Loss Adjustment Expense Paid$23,706
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$430,000$0
Other Expenses$21,000$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:8/12/2008 11:12:41 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 06/09/2008
 
Field ChangedFormer ValueNew Value
Date of Final Disposition18-MAR-0809-JUN-08

 

 

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Dr. Stephen T Enguidanos Medical Malpractice Lawsuits - Court Case # 05-CA-1814-S-JT

Indemnity Paid: $400,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200743811
Claim Number :18533
Date Submitted :3/23/2007
 
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
IndividualStephenTEnguidanos
Insurer TypeStreet Address of Practice
Licensed550 A Twin Cities Boulevard
CityStateZip CodeCounty
NicevilleFL32578Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600969 00$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME86400Surgery - Orthopedic3006

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
TWIN CITIES HOSPITAL100054
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
6/5/20039/12/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Failed back syndrome
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Posterior spinal fusion with instrumentation anterior spinal fusion L-4 to S-1
Diagnostic Code :995.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to recognize and treat blood loss during surgery
Principal Injury Giving Rise To The Claim
Multisystem failure
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/22/200505-CA-1814-S-JT
County Suit Filed inDate of Final Disposition
Okaloosa2/13/2007
Other Defendants Involved in this Claim
Hruby, MD, Robert E
Twin Cities Hospital
Broaderick, MD, Arthur P
Bayshore Anesthesia
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$400,000
Loss Adjust Expense Paid to Defense Counsel$43,654
All Other Loss Adjustment Expense Paid$15,195
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
Risk Management has counseled insured
 
Updates
 
 
Date of Change:3/23/2007 3:15:52 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 1/5/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition01-DEC-0605-JAN-07
 
Date of Change:3/23/2007 3:26:23 PM
Reason for Change:Report updated to reflect correct Court Document final disposition date of 2/13/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition05-JAN-0713-FEB-07

 

 

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Dr. Anthony DeCotis Medical Malpractice Lawsuits - Court Case # 05-CA-2809

Indemnity Paid: $350,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200850020
Claim Number :134256
Date Submitted :8/13/2009
 
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
IndividualAnthony DeCotis
Insurer TypeStreet Address of Practice
Licensed131 NW Beal Parkway
CityStateZip CodeCounty
Fort Walton BeachFL32548Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MP35712$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME45093Rheumatology - No Surgery00000

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Physical Therapy Department 
Date of OccurrenceDate Reported to Insurer
10/31/200311/18/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Rehabilitation post below knee amputation.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Patient admitted for rehabilitation including physical and occupational therapy.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
No misdiagnosis.
Principal Injury Giving Rise To The Claim
Alleged failure to prescribe Lovenox to prevent DVT and PE which resulted in the patient's death.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/5/200505-CA-2809
County Suit Filed inDate of Final Disposition
Okaloosa6/3/2008
Other Defendants Involved in this Claim
Ft. Walton Beach Medical Center, Inc.
Anthony DeCotis, M.D., P.A.
Kenneth Haskin, M.D., P.A.
Markowski, William
Bluewater Orthopedics, P.A.
White Wilson Medical Center
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
Disposed of by Court
Court DecisionOther
Judgment for the defendant. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
6/5/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$350,000
Loss Adjust Expense Paid to Defense Counsel$166,608
All Other Loss Adjustment Expense Paid$65,989
Injured Person's Total Non-Economic Loss$350,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insured has discussed case with insurance company personnel, medical experts and defense counsel.
 
Updates
 
 
Date of Change:8/13/2009 12:21:41 PM
Reason for Change:Report updated to reflect additional legal fees and expenses paid.
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid6284165989
Amount of Loss Adjustment Expense Paid to Defense Counsel165318166608
Indemnity Paid0350000

 

 

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Dr. BILLY BUCKELEW Medical Malpractice Lawsuits - Court Case # 2002-CA1838-S-JT

Indemnity Paid: $350,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200536992
Claim Number :501476
Date Submitted :10/4/2005
 
Insurer Information
 
Insurer NameCoverage Type
AMERICAN HEALTHCARE INDEMNITY COMPANYPrimary
Insurer FEINProfessional License Number
59-2048400 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualTerryMBinns
Street Address
1888 Century Park East, Suite #800
CityStateZip
Los AngelesCA90067
PhoneExtFaxE-Mail Address
(310) 556 - 7488 (310) 556 - 7400Tbinns@scpie-ahi.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualBILLY BUCKELEW
Insurer TypeStreet Address of Practice
Licensed371 Echo Circle
CityStateZip CodeCounty
Fort Walton BeachFL32548Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
0022001074$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME13920Family Physicians or General Practitioners - Minor Surgery0000

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
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
9/14/20001/25/2002
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hypertension.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to monitor hypertension and coumadin levels.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Death.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
5/13/20022002-CA1838-S-JT
County Suit Filed inDate of Final Disposition
Okaloosa9/9/2003
Other Defendants Involved in this Claim
J. Michael Glenn, MD., 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
10/9/2003
 
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$29,043
All Other Loss Adjustment Expense Paid$15,614
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
Interview w/investigators and defense counsel, interrogatories, depositions, etc.
 
Updates
 
No updates found.

 

 

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Dr. Jacob Morgan Medical Malpractice Lawsuits - Court Case # 17-CA-2846

Indemnity Paid: $350,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201885983
Claim Number : 501-441308
Date Submitted : 7/24/2018
 
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 Cindy M Vue
Street Address
3300 Business Park Drive
City State Zip
Stevens Point WI 54482
Phone Ext Fax E-Mail Address
(715) 345 - 8605     cindy.vue@aig.com
 
Insured Information
 
Type First Name MI Last Name
Individual Jacob   Morgan
Insurer Type Street Address of Practice
Licensed 4014 Commons Drive W #114
City State Zip Code County
Destin FL 32541 Okaloosa
Policy Number Per Claim Policy Limits Aggregate Policy Limits
066534454 $1,000,000 $3,000,000
Profession or Business Other Profession or Business
Other Chiropractor
License Number Specialty Code & Classification Certification Number
CH11166    

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 Okaloosa
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
N/A 000000
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
4/12/2016 3/28/2017
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Failure to order xrays resulted in quadriplegia.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Failed to order appropriate diagnostic studies and refer claimant to a specialist for a neurological work-up prior to performing cervical manipulations.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Did not order appropriate diagnostic studies and refer claimant to a specialist.
Principal Injury Giving Rise To The Claim
Suffered bodily injury and resulting pain and suffering, disability, disfigurement, and mental anguish.
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
8/10/2017 17-CA-2846
County Suit Filed in Date of Final Disposition
Okaloosa 6/14/2018
Other Defendants Involved in this Claim
Payne Chiropractic
PAYNE, ALAN
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
6/14/2018
 
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 $9,493
All Other Loss Adjustment Expense Paid $4,825
Injured Person's Total Non-Economic Loss $0
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $250,000 $0
Wage Loss $0 $24,000
Other Expenses $0 $100,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
N/A
 
Updates
 
No updates found.

 

 

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Dr. Randall G Lorenz Medical Malpractice Lawsuits - Court Case # 2007-CA-002005

Indemnity Paid: $325,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200851809
Claim Number :24911
Date Submitted :12/18/2008
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRandallGLorenz
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 05$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME83125Internal Medicine - No Surgery4002

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
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
9/28/20041/2/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Gerd, high blood pressure
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :402.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to timely evaluate and treat coronary artery disease
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
6/14/20072007-CA-002005
County Suit Filed inDate of Final Disposition
Okaloosa11/17/2008
Other Defendants Involved in this Claim
White Wilson 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
11/7/2008
 
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$45,395
All Other Loss Adjustment Expense Paid$15,212
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
Risk management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Robert Rogers Medical Malpractice Lawsuits - Court Case # 2009-CA-0006825

Indemnity Paid: $300,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201056559
Claim Number :28756
Date Submitted :2/22/2010
 
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
IndividualRobert Rogers
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 07$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME41071Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
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
10/11/200711/4/2008
 
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
Lung lobectomy
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose pulmonary embolism
Principal Injury Giving Rise To The Claim
Bilateral pulmonary embolism
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/9/20092009-CA-0006825
County Suit Filed inDate of Final Disposition
Okaloosa2/17/2010
Other Defendants Involved in this Claim
White Wilson Medical 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
2/17/2010
 
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$22,947
All Other Loss Adjustment Expense Paid$10,141
Injured Person's Total Non-Economic Loss$300,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$7,000$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
No updates found.

 

 

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Dr. Thomas A Dlabal Medical Malpractice Lawsuits - Court Case # 05-CA-3818

Indemnity Paid: $300,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200639931
Claim Number :18680
Date Submitted :3/27/2007
 
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
IndividualThomasADlabal
Insurer TypeStreet Address of Practice
Licensed928 D Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PRF1401923 00$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME43055Surgery - Orthopedic2803

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Outpatient FacilityHealthsouth Emerald Coast Surgery Center
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
6/26/20039/12/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Chondromalacia of medial femoral condyle of left knee
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Arthroscopy of left knee
Diagnostic Code :719.46
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to provide informed consent and committed battery for not disclosing his Parkinson's disease to patient
Principal Injury Giving Rise To The Claim
Continued pain
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
9/15/200305-CA-3818
County Suit Filed inDate of Final Disposition
Okaloosa3/6/2007
Other Defendants Involved in this Claim
Orthopaedic Assoc., PA
Emerald 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
3/8/2006
 
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$1,980
All Other Loss Adjustment Expense Paid$558
Injured Person's Total Non-Economic Loss$300,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:3/27/2007 9:31:32 AM
Reason for Change:Report updated to reflect Court Document final disposition date of 03/06/07
 
Field ChangedFormer ValueNew Value
Date of Final Disposition03-MAR-0606-MAR-07

 

 

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Dr. Kenneth B Haskin Medical Malpractice Lawsuits - Court Case # 05-CA-2809

Indemnity Paid: $280,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200849905
Claim Number :22671
Date Submitted :6/19/2008
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualKennethBHaskin
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32548Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 04$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME39182Internal Medicine - No Surgery515

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
TWIN CITIES HOSPITAL100054
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
10/31/20039/13/2005
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Diabetic ulcer
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Debridement with subsequent BKA
Diagnostic Code :415.1
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to restart DVT prophylaxis post-op
Principal Injury Giving Rise To The Claim
Pulmonary embolis
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
7/5/200505-CA-2809
County Suit Filed inDate of Final Disposition
Okaloosa5/16/2008
Other Defendants Involved in this Claim
Markowski, MD, William
Decotis, MD, Anthony
White Wilson Medical Center
Fort Walton Beach Medical Center
Bluewater Orthopaedics
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
5/20/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$280,000
Loss Adjust Expense Paid to Defense Counsel$39,937
All Other Loss Adjustment Expense Paid$18,935
Injured Person's Total Non-Economic Loss$280,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$365$0
Wage Loss$0$0
Other Expenses$8,581$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. Patrick Conrad Medical Malpractice Lawsuits - Court Case # 08CA1375

Indemnity Paid: $275,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200954444
Claim Number :SH-PHY-07-71056
Date Submitted :7/27/2009
 
Insurer Information
 
Insurer NameCoverage Type
LEXINGTON INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
25-1149494 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancyJThomas
Street Address
9821 Katy Freeway
CityStateZip
HoustonTX77024
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualPatrick Conrad
Insurer TypeStreet Address of Practice
Licensed12815 Highway 98 WestSuite 116
CityStateZip CodeCounty
DestinFL32541Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
6794385$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME73998Emergency Medicine - No Major Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Emergency Room 
Name of InstitutionCode
TWIN CITIES HOSPITAL100054
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
11/11/20058/10/2007
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Arterial blood clot
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Flr to properly tx arterial blood clot
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Treatment related
Principal Injury Giving Rise To The Claim
Alleged nerve injury, aggravation of preexisting vascular disease, heart 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
3/10/200808CA1375
County Suit Filed inDate of Final Disposition
Okaloosa7/23/2009
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
2/3/2008
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$275,000
Loss Adjust Expense Paid to Defense Counsel$64,239
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. JUSTIN R JOHNSEN Medical Malpractice Lawsuits - Court Case # 11-CA3405

Indemnity Paid: $262,500.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201264934
Claim Number :287050
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
IndividualJUSTINRJOHNSEN
Insurer TypeStreet Address of Practice
Licensed5296 Commerce Dr, Ste 206
CityStateZip CodeCounty
Salt Lake CityUT84107Out of state
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
738686$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME102249Surgery - Plastic 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
5/22/20094/19/2011
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Left eye pain / soft mass in orbital region
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Anterior orbitotomy with biopsy
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to obtain mri before biopsy
Principal Injury Giving Rise To The Claim
Blindness in left eye
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
8/4/201111-CA3405
County Suit Filed inDate of Final Disposition
Okaloosa4/19/2012
Other Defendants Involved in this Claim
Emerald Coast Eye Partners LLC
Emerald Coast Eye Institute LLC
Emerald Coast Eye 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
4/19/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$262,500
Loss Adjust Expense Paid to Defense Counsel$17,828
All Other Loss Adjustment Expense Paid$10,420
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
N/A
 
Updates
 
 
Date of Change:2/15/2013 12:04:32 PM
Reason for Change:Update ALE
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel1769717828
All Other Loss Adjustment Expense Paid712010420

 

 

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Dr. DANAE R MENDEZ Medical Malpractice Lawsuits - Court Case # 10-CA-6123

Indemnity Paid: $250,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201367328
Claim Number :33047
Date Submitted :7/15/2013
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDANAERMENDEZ
Insurer TypeStreet Address of Practice
Licensed932 Bambi Dr.
CityStateZip CodeCounty
DestinFL32541Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1602495 01$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME39055Radiology - Diagnostic - Minor Surgery 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Outpatient FacilityWhite Wilson Medical Center
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Radiology, Emergency Room 
Date of OccurrenceDate Reported to Insurer
1/17/20082/11/2010
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Fusion of an infant's cranial sagital suture (premature closure of bone plate)
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Dr. Mendez, a radiologist, diagnosed a CT scan of an infant on 01/17/08 with no evidence of craniosynostosis.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose the rare condition of craniosynostosis.However, a nationally recognized radiology expert was of the opinion that the allged misdiagnosis was a subtle finding and was not below the prevailing standard of care for a board-certified radiologist.
Principal Injury Giving Rise To The Claim
Craniosynostosis (premature closure of bone plate of infant).
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
11/3/201010-CA-6123
County Suit Filed inDate of Final Disposition
Okaloosa6/24/2013
Other Defendants Involved in this Claim
Krist, MD, Keith M
Loder, MD, Andrea S
White Wilson 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
5/9/2013
 
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$67,226
All Other Loss Adjustment Expense Paid$14,569
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
Risk management has counseled insured
 
Updates
 
 
Date of Change:7/15/2013 12:32:02 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 6/24/13
 
Field ChangedFormer ValueNew Value
Date of Final Disposition09-MAY-1324-JUN-13

 

 

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