Department File Number : | M201573515 |
Claim Number : | 1013766-01 |
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 | Ali | A | Sultan | ||
Insurer Type | Street Address of Practice | ||||
Licensed | c/o Pine Ridge Medical Center, 350 7th Street North | ||||
City | State | Zip Code | County | ||
Naples | FL | 34102 | Collier | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
757413 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME96258 | Hospitalists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Collier | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD | 23960057 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/4/2012 | 5/30/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
ABDOMINAL PAIN | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
LAPAROSCOPIC CHOLECYSTECTOMY AND POST OP EVALUATION | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
FAILURE TO MONITOR PATIENT AND DIAGNOSE NICKED BOWEL | |||||
Principal Injury Giving Rise To The Claim | |||||
ADDITIONAL SURGERY; PAIN AND SUFFERING | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/20/2013 | 11-2013-CA-001565 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Collier | 2/4/2015 | ||||
Other Defendants Involved in this Claim | |||||
Incisionless PLLC Denk MD, Peter M Innovation Medical Associates PA Physicians Regional Medical Center | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
2/3/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $56,012 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $53,209 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $200,000 | ||||||||||||||||||||
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: | 2/18/2015 3:36:24 PM | |||||||||
Reason for Change: | Corrected Court Case number | |||||||||
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Date of Change: | 8/25/2015 4:37:43 PM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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This page is not displaying certain sensitive information.
Department File Number : | M201573322 |
Claim Number : | 1019149-02 |
Date Submitted : | 1/28/2015 |
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 | Ali | A | Sultan | ||
Insurer Type | Street Address of Practice | ||||
Licensed | c/o Pine Ridge Medical Center, 350 7th Street North | ||||
City | State | Zip Code | County | ||
Naples | FL | 34102 | Collier | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
757413 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME96258 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Collier | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD | 23960057 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/13/2012 | 5/19/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pancytopenia and presumed myelodysplastic syndrome | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Bone marrow biopsy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Unnecessary procedure | |||||
Principal Injury Giving Rise To The Claim | |||||
Complication of retroperitoneal bleed resulting in death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/16/2015 | ||||
Other Defendants Involved in this Claim | |||||
Wang MD, Jay | |||||
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 | |||||
Dropped before Action Filed | |||||
Court Decision | Other | ||||
Other | Not Pursued | ||||
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 | $5,987 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,014 | ||||||||||||||||||||
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 | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. ALI A SULTAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ALI A SULTAN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).