| Department File Number : | M201573335 |
| Claim Number : | 14-0086-A-13 |
| Date Submitted : | 1/11/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Tamla | Lloyd | |||
| Street Address | |||||
| 4651 Salisbury Road, Suite 410 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | BRIAN | CARLSON | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2415 University Pkwy, Suite 111 | ||||
| City | State | Zip Code | County | ||
| Sarasota | FL | 34243 | Sarasota | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG000974 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS10980 | Family Physicians or General Practitioners - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Sarasota | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physician's Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/30/2013 | 4/21/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient was seeing physician as a primary care doctor. She was being treated for several medical conditions including gastrointestinal issues and cardiac issues. Reports of vaginal bleeding. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| None made | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged failure to timely refer the patient to a gynecologist resulting in delay of diagnosing uterine cancer. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 12/30/2014 | ||||
| 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 | |||||
| 12/30/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $70,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $20,341 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstances of this case have been discussed with insured and Risk Management was notified. Risk management has discussed case with insured. | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 1/11/2016 10:28:18 AM | ||||||
| Reason for Change: | Updated LAE amount. | ||||||
| |||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. BRIAN CARLSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BRIAN CARLSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).