Department File Number : | M201783755 |
Claim Number : | 70615-A |
Date Submitted : | 12/1/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-2813188 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | James | P | Lacey | ||
Street Address | |||||
76 South Laura Street, Suite 900 | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (888) 974 - 6458 | claims@medmaldirect.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Arleigh | I | Ancheta | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 8145 Cerebellum Way, Suite 102 | ||||
City | State | Zip Code | County | ||
New Port Richey | FL | 34655 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707385 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7816 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pasco | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
MEASE HOSITAL - COUNTRYSIDE | 110001 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Emergency Room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
9/5/2015 | 12/14/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Urinary tract infection. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Medical management, ultrasound of gallbladder. | |||||
Diagnostic Code : | 09 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to diagnose uterine rupture resulting in death of a 36 week old fetus. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 11/13/2017 | ||||
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 | |||||
11/30/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $24,624 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None. |
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 : | M201987897 |
Claim Number : | 70635-A |
Date Submitted : | 2/13/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-2813188 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | James | P | Lacey | ||
Street Address | |||||
76 S. Laura Street, Suite 900 | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (888) 974 - 6458 | claims@medmaldirect.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Arleigh | Ancheta | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8145 Cerebellum Way, Suite 102 | ||||
City | State | Zip Code | County | ||
New Port Richey | FL | 34655 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707385 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7816 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pasco | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEASE HOSITAL - COUNTRYSIDE | 110001 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/14/2014 | 1/11/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pregnancy with delivery of infant. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Delivery of infant. | |||||
Diagnostic Code : | 09 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to timely deliver infant resulting in death of the fetus. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/27/2016 | 16-006257-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 1/4/2019 | ||||
Other Defendants Involved in this Claim | |||||
Ladies and Babies OBGYN Associate, LLC Trustees of Mease Hospital | |||||
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 | |||||
1/30/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $52,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $27,132 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None. |
Updates | |
No updates found. |
Does Dr. ARLEIGH I ANCHETA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ARLEIGH I ANCHETA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).