Department File Number : | M201885336 |
Claim Number : | 64114 |
Date Submitted : | 5/18/2018 |
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 | Azzam | Muftah | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 12900 Cortez Blvd. Ste. 203 | ||||
City | State | Zip Code | County | ||
Brooksville | FL | 34613 | Hernando | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602930 05 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68485 | Gastroenterology - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hernando | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Endoscopy Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/24/2015 | 10/12/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Chronic constipation | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Colonoscopy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged improper performance of colonoscopy | |||||
Principal Injury Giving Rise To The Claim | |||||
Perforation | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/25/2018 | 2018-CA-000036 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hernando | 5/9/2018 | ||||
Other Defendants Involved in this Claim | |||||
Access Health Care | |||||
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 | |||||
5/9/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $165,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $18,812 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,076 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201783807 |
Claim Number : | 56276 |
Date Submitted : | 12/8/2017 |
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 | Azzam | Muftah | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 12900 Cortez Blvd., Ste. 203 | ||||
City | State | Zip Code | County | ||
Brooksville | FL | 34613 | Hernando | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602930 03 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68485 | Internal Medicine - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hernando | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Florida Endoscopy & Surgery Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/5/2015 | 1/21/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Polyps | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Colonoscopy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to properly perform procedure | |||||
Principal Injury Giving Rise To The Claim | |||||
Injury to spleen | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/27/2016 | 2016-CC-515 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hernando | 11/29/2017 | ||||
Other Defendants Involved in this Claim | |||||
Access Health Care LLC Florida Endoscopy & Surgery Center, LLC | |||||
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 | |||||
11/29/2017 |
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 | $66,310 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11,931 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Does Dr. AZZAM MUFTAH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. AZZAM MUFTAH, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).