Department File Number : | M201678577 |
Claim Number : | 13-0052-A-12 |
Date Submitted : | 5/26/2016 |
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 | Dionysia | Lawson | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Carol | Sims-Robertson | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 2191 9th Ave. N. Suite 100 | ||||
City | State | Zip Code | County | ||
St. Petersburg | CA | 33713 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
12102 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME87149 | Dermatology - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pinellas | ||||
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 | Divine Dermatology | ||||
Date of Occurrence | Date Reported to Insurer | ||||
9/4/2012 | 2/13/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented for annual skin check up and was diagnosed with sebaceous hyperplasia | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent treatment to remove benign lesions on forehead and cheeks. Acid solution was applied. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None Shown | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient did not return for follow for several weeks. When she did return, she had scarring where the treated lesions had become infected. | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/29/2014 | 14-004846-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 4/1/2016 | ||||
Other Defendants Involved in this Claim | |||||
Divine Dermatology, PLLC | |||||
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 | |||||
4/1/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $130,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $46,922 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of this case were discussed with the insured and risk management was notified. Risk management discussed the case with the insured |
Updates | |
No updates found. |
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Does Dr. CAROL SIMS-ROBERTSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CAROL SIMS-ROBERTSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).