Department File Number : | M201679752 |
Claim Number : | 1024650-01 |
Date Submitted : | 2/2/2018 |
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 | Range | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7480 SW 40th Street, Ste 700 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33155 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
767024 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME95511 | Pathology - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Dade | ||||
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 | ||||
2/11/2014 | 3/3/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Annual screening | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Mammogram | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Wrong type of breast cancer diagnosed | |||||
Principal Injury Giving Rise To The Claim | |||||
One month delay in diagnosis | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/19/2016 | ||||
Other Defendants Involved in this Claim | |||||
Vitro Molecular Laboratories LLC | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
Court Decision | Other | ||||
Other | Not Pursued | ||||
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 | $7,160 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,275 | ||||||||||||||||||||
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 | |||||||
Date of Change: | 2/21/2017 2:02:52 PM | ||||||
Reason for Change: | ALE UPDATE 2/21/2017 | ||||||
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Date of Change: | 8/22/2017 8:32:13 AM | ||||||
Reason for Change: | ALE UPDATE 8/22/2017 | ||||||
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Date of Change: | 2/2/2018 9:48:14 AM | ||||||
Reason for Change: | ALE UPDATE 2/2/2018 | ||||||
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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. DANIELLE RANGE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DANIELLE RANGE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).