Department File Number : | M201987690 |
Claim Number : | JH-15HL-328470 |
Date Submitted : | 1/23/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Jackson Healthcare, Inc. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
81-0652936 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | BRAD | E | MCCOLLOM | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 2655 NORTHWINDS PARKWAY | ||||
City | State | Zip Code | County | ||
ALPHARETTA | GA | 30009 | Out of state | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HN006655 | $1,000,000 | $2,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS9270 | Physicians or Surgeons |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Lucie | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
LAWNWOOD REG. MED. CTR | 100246 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/16/2014 | 3/8/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
NECK AND SHOULDER PAIN | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEEN IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
FAILURE TO PROPERLY DIAGNOSE AND TREAT | |||||
Principal Injury Giving Rise To The Claim | |||||
RESULTING IN PARAPLEGIA | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/14/2016 | 562016CA001815 | ||||
County Suit Filed in | Date of Final Disposition | ||||
St. Lucie | 1/23/2019 | ||||
Other Defendants Involved in this Claim | |||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
12/26/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $99,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $157,818 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $13,378 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN |
Updates | |
No updates found. |
Department File Number : | M201574488 |
Claim Number : | 152171 |
Date Submitted : | 6/23/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Teresa | Ross | |||
Street Address | |||||
One Park Plaza P.O. Box 555 | |||||
City | State | Zip | |||
Nashville | TN | 37202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Brad | McCollom | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8005 Bay Street Suite 5 | ||||
City | State | Zip Code | County | ||
Sebastian | FL | 32958 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10113 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS9270 | Surgery - Neurology - Including Child | 01 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Lucie | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
LAWNWOOD REG. MED. CTR | 100246 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/5/2013 | 4/28/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Herniated lumbar disc L3-L4, L4-L5. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent lumbar diskectomy at L3-L4 & L4-L5 via laminectomy. As surgeon was preparing to close, patient blood pressure was dropping. Posterior laceration was found & repaired. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Laceration of distal aorta. | |||||
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 | 4/24/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $6,603 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,032 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Review of policies and procedures. |
Updates | |||||||||||||||||||
Date of Change: | 5/26/2015 3:03:43 PM | ||||||||||||||||||
Reason for Change: | Additional LAE payments made. | ||||||||||||||||||
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Date of Change: | 6/23/2015 7:12:42 AM | ||||||||||||||||||
Reason for Change: | Additional LAE payments made. | ||||||||||||||||||
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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. BRAD E MCCOLLOM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BRAD E MCCOLLOM, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).