Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
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Department File Number : | M201575590 |
Claim Number : | 52079 |
Date Submitted : | 12/1/2015 |
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 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ARDESHIR | KHADEMI-KERMANSHAHI | |||
Insurer Type | Street Address of Practice | ||||
Licensed | PO Box 5048 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33758 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1601361 11 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME80114 | Neurology - Including Child - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEASE HOSPITAL - DUNEDIN | 100043 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/6/2013 | 1/26/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Cervical spinal cord compression | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged delay in diagnosis of cervical spinal cord compression | |||||
Principal Injury Giving Rise To The Claim | |||||
Right leg uniplegia/right arm weakness | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/4/2015 | 2015-CA-000071 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 9/29/2015 | ||||
Other Defendants Involved in this Claim | |||||
Mease Dunedin Hospital Mischan, MD, Byron C Radiology Associates of Clearwater Kanaan, MD, Elias | |||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
8/11/2015 |
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 | $6,698 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $9,621 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |||||||
Date of Change: | 12/1/2015 3:03:47 PM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 9/29/15 | ||||||
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Department File Number : | M201886804 |
Claim Number : | 53335 |
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 | ARDESHIR | KHADEMI-KERMANSHAHI | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1840 Mease Dr. Ste. 4078 | ||||
City | State | Zip Code | County | ||
Safety Harbor | FL | 34695 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1601361 11 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME80114 | Neurology - Including Child - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | 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 | ||||
11/9/2012 | 5/20/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Intra-orbital fungal infection | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged delay in diagnosis and treatment of intra-orbital fungal infection | |||||
Principal Injury Giving Rise To The Claim | |||||
Left eye enucleation | |||||
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 | ||||
9/18/2015 | 15-005872-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 9/10/2018 | ||||
Other Defendants Involved in this Claim | |||||
Dupree, MD, Dana M The Macular Center Handza, DO, Jason M Gulf Coast Retina Center Countryside Neurology | |||||
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 | $33,622 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $12,733 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |
No updates found. |
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Does Dr. ARDESHIR KHADEMI-KERMANSHAHI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ARDESHIR KHADEMI-KERMANSHAHI, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).