Department File Number : | M201575469 |
Claim Number : | 59194801 |
Date Submitted : | 8/10/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PHYSICIANS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
13-4235490 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Antrine | Long | |||
Street Address | |||||
361 Hillsboro Blvd. | |||||
City | State | Zip | |||
Deerfield Beach | FL | 33441 | |||
Phone | Ext | Fax | E-Mail Address | ||
(954) 788 - 5184 | (954) 944 - 1382 | along@picinsurance.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ATHANASIOS | D | ZACHOS | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 131 Redstone Avenue, Suite 102 | ||||
City | State | Zip Code | County | ||
Crestview | FL | 32539 | Okaloosa | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
131031 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME38087 | Surgery - Urological |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Okaloosa | ||||
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 | ||||
Recovery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/13/2012 | 10/4/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to undergo a vasectomy | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent outpatient vasectomy at the insured's office. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
After the vasectomy procedure, patient was in recovery. He got up and fell to the floor and broke 3 teeth and received a forehead laceration. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/6/2015 | 2015-CA-22184277 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Okaloosa | 7/24/2015 | ||||
Other Defendants Involved in this Claim | |||||
Okaloosa-Walton Urology, P.A. 21st Century Oncology fka Radiation Therapy Services, 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 | |||||
8/3/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $27,625 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $7,315 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $7 | ||||||||||||||||||||
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 to address |
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.
Does Dr. ATHANASIOS D ZACHOS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ATHANASIOS D ZACHOS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).