Department File Number : | M202091063 |
Claim Number : | 67868 |
Date Submitted : | 1/16/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Markavia | D | Martin | ||
Street Address | |||||
3535 Piedmont Rd NE, Building 14 Suite 1000 | |||||
City | State | Zip | |||
Atlanta | GA | 30305 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 842 - 5600 | mmartin@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ANDREW | p | DEWOLFE | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 455 Pinellas Street, Suite 400 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33756 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602010 12 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME123778 | Cardiovascular Disease - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
CLEARWATER COMMUNITY HOSPITAL | 100174 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physicians office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
8/7/2017 | 3/26/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
elevated blood pressure and atrial fibrillation | |||||
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 determine patient¿s PT/INR levels; alleged failure to admit the patient to the hospital. The patient subsequently expired. | |||||
Principal Injury Giving Rise To The Claim | |||||
stroke resulting in death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
6/25/2019 | 19-CA-001921 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 1/6/2020 | ||||
Other Defendants Involved in this Claim | |||||
Strikowsky, Stuart B Countryside Medical Clinic Kay, Walter Clearwater Cardiovascular and Interventional Cosultants Rose, Lisa Laboratory Corporation of America | |||||
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 not subject to Arbitration. | |||||
Date of Payment | |||||
12/13/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $195,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $12,489 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $204 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk Management has counseled insured |
Updates | |
No updates found. |
Department File Number : | M201886806 |
Claim Number : | 67868 |
Date Submitted : | 10/22/2018 |
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 | Andrew | P | DeWolfe | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 455 Pinellas St. Ste. 400 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33756 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602010 12 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME123778 | Cardiovascular Disease - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
8/7/2017 | 3/26/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Hypertension | |||||
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 monitor INR/PT levels | |||||
Principal Injury Giving Rise To The Claim | |||||
Ruptured parenchymal hematoma | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/10/2018 | ||||
Other Defendants Involved in this Claim | |||||
Rose, ARNP, Lisa Kay, DO, Walter Strikowsky, DO, Stuart | |||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $5,345 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $59 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk management has counseled insured |
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. ANDREW P DEWOLFE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANDREW P DEWOLFE, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).