Department File Number : | M201575807 |
Claim Number : | 1011012-01 |
Date Submitted : | 9/18/2015 |
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 | Myra | J | Lassen | ||
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 | ANTHONY | A | ZEMBRZUSKI | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1508 Emerald Isle Point | ||||
City | State | Zip Code | County | ||
Apopka | FL | 32703 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
A11965 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Physcian Assistant | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA3083 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
ORLANDO REGIONAL MEDICAL CENTER | 100006 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/12/2011 | 11/24/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Back pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Assist with spinal surgery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to prevent injury to spinal cord | |||||
Principal Injury Giving Rise To The Claim | |||||
Permanent neurological injury | |||||
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 | ||||
5/13/2013 | 2013-CA-2849 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 1/20/2014 | ||||
Other Defendants Involved in this Claim | |||||
Strokes, CRNA, Matthew C Orlando Health Inc Orlando Regional Medical Center Jewett Orthopedic Clinic Meinhardt, Philip Wolverine Anesthesia Consultants MD PA Montalvo MD, Rafael Oh, MD, Young Precision Surgical Services Aquino, Russell | |||||
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 | $9,748 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | |
No updates found. |
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Does Dr. ANTHONY A ZEMBRZUSKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANTHONY A ZEMBRZUSKI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).