Department File Number : | M201886430 |
Claim Number : | HPT 1493 |
Date Submitted : | 9/13/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SLADE, CLEMENT | Primary | ||||
Insurer FEIN | Professional License Number | ||||
71-0908976 | ME40228 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Carol | Wiseheart | |||
Street Address | |||||
747 S Ridgewood Ave. | |||||
City | State | Zip | |||
Daytona Beach | FL | 32114 | |||
Phone | Ext | Fax | E-Mail Address | ||
(386) 310 - 7969 | (386) 310 - 7973 | cwiseheart@halifaxins.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Clement | Slade | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 911 John Anderson Drive | ||||
City | State | Zip Code | County | ||
Ormond Beach | FL | 32176 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
00-89 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME40228 | Surgery - Plastic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Volusia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/28/2013 | 6/5/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Squamous cell carcinoma | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Excision of skin cancers | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Malignant involvement of bone and direct extension of cancer. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/29/2017 | 2017 31769 CICI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Volusia | 8/21/2018 | ||||
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 not subject to Arbitration. | |||||
Date of Payment | |||||
8/9/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $32,836 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11,100 | ||||||||||||||||||||
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 | |||||||||||||||||||||
n/a |
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.
Department File Number : | M201679267 |
Claim Number : | HPT 1486 |
Date Submitted : | 7/26/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SLADE, CLEMENT | Primary | ||||
Insurer FEIN | Professional License Number | ||||
71-0908976 | ME40228 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Carol | Wiseheart | |||
Street Address | |||||
747 Ridgewood Ave. | |||||
City | State | Zip | |||
Daytona Beach | FL | 32114 | |||
Phone | Ext | Fax | E-Mail Address | ||
(386) 310 - 7969 | (386) 310 - 7969 | cwiseheart@halifaxins.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Clement | l | Slade | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 3635 Clyde Morris Blvd. Suite 400 | ||||
City | State | Zip Code | County | ||
Port Orange | FL | 32129 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
00-89 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME40228 | Surgery - Plastic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Volusia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | no other location involved | ||||
Name of Institution | Code | ||||
SURGERY CENTER OF VOLUSIA, LLC | 14960470 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/29/2015 | 5/19/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
cosmetic facial surgery | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
upper and lower blepharoplasty, juvederm injection to the marionette lines and botox. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient perceives less than optimal post op result from his cosmetic surgery. | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 6/27/2016 | ||||
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 | |||||
6/27/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $4,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $240 | ||||||||||||||||||||
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 | |||||||||||||||||||||
on going risk management |
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. CLEMENT SLADE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CLEMENT SLADE, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).