Department File Number : | M201472434 |
Claim Number : | 1018517-01 |
Date Submitted : | 1/27/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Susan | K | Spielman | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | B | J | WALLIS | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 6152 W Corporate Oaks Drive | ||||
City | State | Zip Code | County | ||
Crystal River | FL | 34429 | Citrus | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
720359 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME48685 | Gastroenterology - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Citrus | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
CITRUS MEMORIAL HOSPITAL | 100023 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/1/2012 | 3/31/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Abdominal pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Lparoscopic cholecystectomy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Improper performance of ERCP | |||||
Principal Injury Giving Rise To The Claim | |||||
Perforation of common bile duct; additional surgery | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 8/27/2015 | ||||
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 | |||||
8/26/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $249,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,081 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $8,271 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $124,750 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||||||||||||||||||||||||||||||||||||||
Date of Change: | 9/1/2015 10:47:58 AM | |||||||||||||||||||||||||||||||||||||||||||||
Reason for Change: | Case was reopened in January 2015 and settled and closed in August 2015. | |||||||||||||||||||||||||||||||||||||||||||||
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Date of Change: | 1/27/2016 3:31:45 PM | |||||||||||||||||||||||||||||||||||||||||||||
Reason for Change: | ALE UPDATE 1/27/2016 | |||||||||||||||||||||||||||||||||||||||||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. B J WALLIS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. B J WALLIS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).