Department File Number : | M201782567 |
Claim Number : | SHI-16R-330649 |
Date Submitted : | 7/14/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CONTINENTAL CASUALTY COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-2114545 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | DAVID | B | KOZLOV | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1800 SE TIFFANY AVE. | ||||
City | State | Zip Code | County | ||
PORT SAINT LUCIE | FL | 34952 | St. Lucie | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HAZ4032218126-1 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME105953 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Lucie | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Hospital/Institution | SAINT LUCIE MEDICAL CENTER | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/14/2015 | 4/18/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
LEFT LOWER EXTREMITY SWELLING | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
TIPS PROCEDURE WAS DONE. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
NO MISDIAGNOSIS | |||||
Principal Injury Giving Rise To The Claim | |||||
IMPROPER TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT RESULTING IN DEATH. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/14/2016 | 2016-CA-001804 | ||||
County Suit Filed in | Date of Final Disposition | ||||
St. Lucie | 7/6/2017 | ||||
Other Defendants Involved in this Claim | |||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
6/13/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $26,184 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,743 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN |
Updates | |
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Does Dr. DAVID B KOZLOV, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID B KOZLOV, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).