| Department File Number : | M201676799 |
| Claim Number : | 155358-5 |
| Date Submitted : | 1/8/2016 |
| 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 | Allison | Fleckner | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2801 North State Road 7 | ||||
| City | State | Zip Code | County | ||
| Margate | FL | 33063 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10113 | $5,000,000 | $10,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Other | Registered Nurse | ||||
| License Number | Specialty Code & Classification | Certification Number | |||
| RN9347179 | |||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| NORTHWEST MEDICAL CENTER | 100189 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Labor and Delivery Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/3/2013 | 6/5/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Birth. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Infant born on 8/3/13 with APGARS 3/3/3 with no spontaneous movements & thick meconium staining. Infant transferred to Joe DiMaggio Children's Hospital on 8/4/13 with perinatal asphyxia, at risk for sepsis, meconium aspiration syndrome, suspected for pulmonary hypertension & respiratory distress syndrome. Infant withdrawn from life support & expired on 8/4/13. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 12/22/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Royal Palm OB/Gyn, P.C. Dennis, D.O., Tara Zafran, M.D., Bruce Saver, CNM, MSN, ARNP, Karen Navarette, CNM, MSN, ARNP, Nicole | |||||
| 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 | |||||
| 12/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $738 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $168 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $500 | ||||||||||||||||||||
| 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 | |
| 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. ALLISON FLECKNER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ALLISON FLECKNER, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).