| Department File Number : | M201783216 |
| Claim Number : | 25126-01 |
| Date Submitted : | 9/28/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PODIATRY INSURANCE COMPANY OF AMERICA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 58-1403235 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Angeline | Schave | |||
| Street Address | |||||
| 3000 Meridian Blvd. Ste. 400 | |||||
| City | State | Zip | |||
| Franklin | TN | 37067 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 371 - 8776 | 2998 | (615) 986 - 1945 | aschave@picagroup.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | David | A | Simonson | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1950 Rockledge Blvd., Ste. 107 | ||||
| City | State | Zip Code | County | ||
| Rockledge | FL | 32955 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 1PD0050104 | $500,000 | $1,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Podiatric Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| PO2762 | |||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Brevard | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| CAPE CANAVERAL HOSPITAL | 100177 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/10/2015 | 3/21/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Rupture of the right tibialis anterior tendon | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Open repair of the right tibialis anterior tendon | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient was referred to insured and presented on 2/2/2015 with complaints of a foot slap. Insured performed surgery on 2/10/2015. Patient alleges failure to surgically correct the ruptured anterior tibialis tendon. | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 9/21/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | ||||
| No Court Proceedings. | |||||
| 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 | $2,963 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $750 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Specialty code #80993 | |||||||||||||||||||||
| 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 : | M201884190 |
| Claim Number : | 24750-01 |
| Date Submitted : | 1/26/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PODIATRY INSURANCE COMPANY OF AMERICA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 58-1403235 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Angeline | Schave | |||
| Street Address | |||||
| 3000 Meridian Blvd. Ste. 400 | |||||
| City | State | Zip | |||
| Franklin | TN | 37067 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 371 - 8776 | 2998 | (615) 986 - 1945 | aschave@picagroup.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | David | A | Simonson | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1950 Rockledge Blvd., Ste. 107 | ||||
| City | State | Zip Code | County | ||
| Rockledge | FL | 32955 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 1PD0050104 | $500,000 | $1,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Podiatric Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| PO2762 | |||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Brevard | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| WUESTHOFF MEMORIAL HOSPITAL | 23960034 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/10/2016 | 12/20/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Ankle Pain, left; blistering | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Venous duplex scan, Augmentin prescription and compression dressing | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient was non compliant. Allegations unknown at this time. | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 12/12/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | ||||
| No Court Proceedings. | |||||
| 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 | $2,664 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $312 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Specialty Code - 80993 | |||||||||||||||||||||
| 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. DAVID A SIMONSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID A SIMONSON, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).