Department File Number : | M201679680 |
Claim Number : | 2013-01002 |
Date Submitted : | 9/12/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CRUDEN BAY RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-0057453 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Rachel | Kehoe | |||
Street Address | |||||
135 Allen Brook Lane | |||||
City | State | Zip | |||
Williston | VT | 05495 | |||
Phone | Ext | Fax | E-Mail Address | ||
(802) 371 - 2218 | (802) 229 - 6280 | rkehoe@usarisk.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ann Marie | M | LeVine | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 13535 Nemours Parkway | ||||
City | State | Zip Code | County | ||
Orlando | FL | 32827 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CBRRG 2013 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME94546 | Pediatrics - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NEMOURS CHILDRENS HOSPITAL | 23960096 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Critical Care Unit | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/1/2013 | 11/12/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
two week history of poor oral intake and irritability; with surprise finding of critical sodium level. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
administration of sodium | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Sodium level was appropriately recognized | |||||
Principal Injury Giving Rise To The Claim | |||||
brain injury allegedly related to sodium administration | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/29/2015 | 2015-CA-010013-O | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 8/26/2016 | ||||
Other Defendants Involved in this Claim | |||||
The Nemours Foundation | |||||
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 | |||||
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 | $45,601 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $12,000 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Root Cause Analysis done |
Updates | |
No updates found. |
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Does Dr. ANN MARIE M LEVINE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANN MARIE M LEVINE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).