Department File Number : | M201679458 |
Claim Number : | 136594 |
Date Submitted : | 7/20/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL FIRE INSURANCE COMPANY OF HARTFORD | Primary | ||||
Insurer FEIN | Professional License Number | ||||
06-0464510 | |||||
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 | Abdulaziz | Al Khafaji | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 5411 Grand Blvd. Suite 109 | ||||
City | State | Zip Code | County | ||
New Port Richey | FL | 34652 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HAZ2075006282 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME50610 | Surgery - General | 01 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MORTON PLANT HOSPITAL | 100127 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/13/2008 | 11/14/2008 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Chronic calculous cholecystitis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
During laparoscopic cholecystectomy, common bile duct was transected. Surgery was converted to open operation & Roux-en-Y hepaticojejunostomy was performed to repair common bile duct. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Transection of common bile duct. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/11/2011 | 412011CA0176WS | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 8/9/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
7/26/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $77,932 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $30,371 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $25,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Review of policies and procedures. |
Updates | ||||||||||
Date of Change: | 7/20/2017 10:48:55 AM | |||||||||
Reason for Change: | Additional LAE payments made. | |||||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Department File Number : | M201573669 |
Claim Number : | 5148039-01 |
Date Submitted : | 8/25/2015 |
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 | ABDULAZIZ | AL KHAFAJI | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 5411 Grand Blvd, Ste 109 | ||||
City | State | Zip Code | County | ||
New Port Richey | FL | 34652 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
733258 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME50610 | Surgery - Vascular |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pasco | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MORTON PLANT HOSPITAL | 100127 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/27/2009 | 7/25/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Gallbladder | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Surgery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Transected bile duct | |||||
Principal Injury Giving Rise To The Claim | |||||
Pain and suffering | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/1/2011 | 512011-CA-5739 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 2/26/2015 | ||||
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 | |||||
Disposed of by Court | |||||
Court Decision | Other | ||||
Directed verdict for defendant. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $78,645 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $42,217 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 8/25/2015 4:58:48 PM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. ABDULAZIZ AL KHAFAJI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ABDULAZIZ AL KHAFAJI, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).