Department File Number : | M201676824 |
Claim Number : | 1013318-01 |
Date Submitted : | 8/9/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FLORIDA MEDICAL MALPRACTICE JUA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-1625412 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | SUSAN | SPIELMAN | |||
Street Address | |||||
5814 Reed Street | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | (260) 486 - 0782 | SUSAN.SPIELMAN@MEDPRO.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | A | Cheesman | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2121 5th Ave North | ||||
City | State | Zip Code | County | ||
St Petersburg | FL | 33713 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL004244 | $100,000 | $300,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS4187 | 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 | Orange | ||||
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 | ||||
8/6/2012 | 4/15/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Trigger point injections | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to provide proper follow up care and instruction | |||||
Principal Injury Giving Rise To The Claim | |||||
Adverse reaction to injection | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/6/2013 | 2013-CA-011231-0 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 1/6/2016 | ||||
Other Defendants Involved in this Claim | |||||
Carder, Robert G Health Matters LLC | |||||
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 | |||||
1/4/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $35,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $24,940 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $9,072 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $33,850 | ||||||||||||||||||||
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: | 8/9/2016 2:32:20 PM | |||||||||
Reason for Change: | ALE UPDATED 8/9/2016 | |||||||||
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Does Dr. DAVID A CHEESMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID A CHEESMAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).