Department File Number : | M201575326 |
Claim Number : | 14-0139-A-13 |
Date Submitted : | 2/3/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tamla | Lloyd | |||
Street Address | |||||
4651 Salisbury Road, Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ashish | Shah | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 302 1st Street North | ||||
City | State | Zip Code | County | ||
Winter Haven | FL | 33881 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS000735 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME70933 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
WINTER HAVEN HOSPITAL | 100052 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/24/2013 | 8/22/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient was taken by EMS to Winter Haven Hospital with complaints of shortness of breath, right chest pain. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
None shown | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None made | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to order appropriate diagnostic studies prior to discharging the patient. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/11/2015 | 2015-CA-000088 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 6/23/2015 | ||||
Other Defendants Involved in this Claim | |||||
Winter Haven Hospital, Inc. | |||||
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 | |||||
6/23/2015 |
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 | $21,522 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of this case have been discussed with the insured and risk management was notified. Risk management has discussed case with the insured. |
Updates | |||||||
Date of Change: | 2/3/2016 8:44:08 AM | ||||||
Reason for Change: | Updated LAE amount. | ||||||
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Department File Number : | M201990409 |
Claim Number : | CLA0390863 |
Date Submitted : | 10/28/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NORCAL MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
94-2301054 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Steven | R | Carey | ||
Street Address | |||||
4651 Salisbury Rd. Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 309 - 8127 | (904) 309 - 8127 | scarey@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ashish | Shah | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 350 1st St. North | ||||
City | State | Zip Code | County | ||
Winter Haven | FL | 33881 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
722487N | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME70933 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
WINTER HAVEN HOSPITAL | 100052 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/22/2015 | 1/5/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with complaints of abdominal pain and related symptoms. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Physician treated the patients complaints with antibiotic therapy. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleging a failure to timely treat with aggressive antibiotic therapy. | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient expired. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/6/2018 | 2018-CA-002074 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 8/15/2019 | ||||
Other Defendants Involved in this Claim | |||||
Winter Haven Hospital, Inc. Aronski, MD, Wojtek Honer, MD, Richard Thomas, MD, Robert Reddy, MD, Ashok Rodriguez, MD, Ofelio Shamim, MD, Talha | |||||
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 | |||||
8/15/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $99,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $40,099 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of the case have been discussed with the insured and Risk Management. |
Updates | |
No updates found. |
Does Dr. ASHISH SHAH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ASHISH SHAH, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).