Department File Number : | M201679663 |
Claim Number : | 38664 |
Date Submitted : | 10/8/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Autry | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 3725 11th Circle | ||||
City | State | Zip Code | County | ||
Vero Beach | FL | 32960 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602269 04 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME25634 | Radiology - interventional |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Vero Radiology Associates | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/9/2011 | 9/14/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Mid back pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Thoracic spine x-ray | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose thoracic spine lesion | |||||
Principal Injury Giving Rise To The Claim | |||||
Paraplegia | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/3/2013 | 31-2013-CA-000005 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Indian River | 8/18/2016 | ||||
Other Defendants Involved in this Claim | |||||
Vero Radiology Associates Sarback, DC, Todd | |||||
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 | |||||
8/9/2016 |
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 | $51,435 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $16,133 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |||||||
Date of Change: | 10/8/2016 9:15:54 AM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 08/18/16 | ||||||
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Does Dr. DAVID AUTRY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID AUTRY, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).