Department File Number : | M201472515 |
Claim Number : | 14-02-70300-A |
Date Submitted : | 11/4/2014 |
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 | William | S | Bliss | ||
Street Address | |||||
1 Independent Drive | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (904) 354 - 4813 | saunders@mymedmal.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | BETTINA | KOHAUT | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 836 Prudential Drive, Suite 1506 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32207 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707114 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME86428 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
BAPTIST MEDICAL CENTER AND WOLFSON | 100088 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/8/2013 | 2/19/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Ovarian cyst. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Bilateral oophorectomy. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to completely remove left ovary. | |||||
Principal Injury Giving Rise To The Claim | |||||
Subsequent surgery needed. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/24/2014 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/24/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $1,758 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Company personnel consulted with insured. |
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. BETTINA KOHAUT, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BETTINA KOHAUT, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).