Department File Number : | M201679740 |
Claim Number : | 1022060-03 |
Date Submitted : | 2/21/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Danielle | M | Francis | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2051 Mayo Drive | ||||
City | State | Zip Code | County | ||
Tavares | FL | 32778 | Lake | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
718662 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Physician Assistant | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9103962 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lake | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Radnothy-Perry Orthopaedic Center PA | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
8/9/2012 | 10/24/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Left elbow fracture | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Evaluated patient and consulted physician | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to perform reduction | |||||
Principal Injury Giving Rise To The Claim | |||||
Displaced elbow; need for second surgery | |||||
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 | ||||
9/23/2015 | 35-2015-CA-001757 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lake | 9/15/2016 | ||||
Other Defendants Involved in this Claim | |||||
Perry MD, Donald J Radnothy-Perry Orthopaedic Center PA | |||||
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 | |||||
8/16/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $7,022 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,024 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $83,333 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 9/26/2016 8:27:03 AM | |||||||||
Reason for Change: | Updated treatment field per file manager | |||||||||
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Date of Change: | 2/21/2017 11:09:45 AM | |||||||||
Reason for Change: | ALE UPDATE 2/21/2017 | |||||||||
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Does Dr. DANIELLE M FRANCIS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DANIELLE M FRANCIS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).