| Department File Number : | M201576595 |
| Claim Number : | EMC-FL-15-287546 |
| Date Submitted : | 12/17/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EmCare Holdings, Inc. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 75-173235 | SI | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 9821 Katy Freeway | |||||
| City | State | Zip | |||
| Houston | TX | 77024 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ANNETTE | M | BRENNER | ||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 119 OAKFIELD DRIVE | ||||
| City | State | Zip Code | County | ||
| BRANDON | FL | 33511 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HAZ1040025381-13 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME70818 | Emergency Medicine - No Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | BRANDON REGIONAL MEDICAL CENTER | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/19/2014 | 4/2/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| MSSA | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| TREATED AND DISCHARGED | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| VIRAL SYNDROME | |||||
| Principal Injury Giving Rise To The Claim | |||||
| SEPSIS AND 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 | 11/11/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Settlement Reached Prior to Pre-Suit Period | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 11/10/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $18,143 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| 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.
| Department File Number : | M201678348 |
| Claim Number : | 156986 |
| Date Submitted : | 3/17/2017 |
| 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 | Annette | Brenner | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 119 Oakfield Drive | ||||
| City | State | Zip Code | County | ||
| Brandon | FL | 33511 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10115 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME70818 | Emergency Medicine - Including Major Surgery | 01 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| BRANDON REGIONAL HOSPITAL | 100243 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Emergency Room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/1/2015 | 8/1/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Acute appendicitis. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Allege failure to order CT of abdomen/pelvis &/or surgery consult, resulting in delayed diagnosis of appendicitis & ruptured appendix. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Patient presented to ER with complaint of right lower quadrant abdominal pain, low grade fever, nausea & vomiting. Patient found to have elevated white blood count, positive Strep & elevated C-Reactive Protein. Appendix could not be visualized on ultrasound due to excessive bowel gas. Patient diagnosed with Strep throat & abdominal pain & discharged home. Patient returned next day with worsening abdominal pain, nausea, fever & loss of appetite. Patient taken to OR for laparoscopic appendectomy for acute appendicitis & found to have a ruptured appendix & serosal tear of colon. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Ruptured appendix. | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 4/22/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| 3/28/2016 | |||||
| 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 | $18,829 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $6,121 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $200,000 | ||||||||||||||||||||
| 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: | 3/17/2017 10:34:11 AM | ||||||||||||
| Reason for Change: | Additional LAE payments made. Corrected Non Economic loss amount. | ||||||||||||
| |||||||||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. ANNETTE M BRENNER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANNETTE M BRENNER, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).