| Department File Number : | M201885850 |
| Claim Number : | 158450-2 |
| Date Submitted : | 7/11/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Christina | J | Stoker | ||
| Street Address | |||||
| 1100 Charlotte Ave, Ste 500 | |||||
| City | State | Zip | |||
| Nashville | TN | 37203 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 1779 | (615) 344 - 5889 | christina.stoker@hcahealthcare.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | DAVID | K | MEHTA | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 8333 N DAVIS HWY | ||||
| City | State | Zip Code | County | ||
| PENSACOLA | FL | 32514 | Escambia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10116 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME59672 | Surgery - Obstetrics - Gynecology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Escambia | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| WEST FLORIDA REG. MED. CTR (PENSACOLA) | 100231 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/6/2016 | 6/13/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| CARE AND TREATMENT OF FEMALE PATIENT WITH CHRONIC LEFT-SIDE PELVIC PAIN. EXTENSIVE MEDICAL HISTORY REGARDING PAIN, TREATMENT AND TESTING. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| PELVIC ULTRASOUND APPEARED NORMAL; UNDERWENT DIAGNOSTIC LAPARSCOPY AND LEFT SALPINGO-OOPHORECTOMY. CYST WAS PRESENT ON RIGHT OVARY SO BOTH CYST AND OVARY WERE REMOVED. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| ALLEGATIONS OF CONTINUED CHRONIC PELVIC PAIN. | |||||
| 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 | 6/28/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Settlement Reached Prior to Pre-Suit Period | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 6/7/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $82,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $4,457 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $958 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $70,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| REVIEW OF POLICIES AND PROCEDURES. | |||||||||||||||||||||
| 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 : | M201573716 |
| Claim Number : | 150946-2 |
| Date Submitted : | 3/10/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Teresa | Ross | |||
| Street Address | |||||
| One Park Plaza P.O. Box 555 | |||||
| City | State | Zip | |||
| Nashville | TN | 37202 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | David | Mehta | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 8333 North Davis Highway | ||||
| City | State | Zip Code | County | ||
| Pensacola | FL | 32514 | Escambia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10113 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME59672 | Surgery - Obstetrics - Gynecology | 01 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Escambia | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| WEST FLORIDA REG. MED. CTR (PENSACOLA) | 100231 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/18/2013 | 12/9/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Right ovarian cysts, endometriosis. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| On 11/18/13, patient underwent diagnostic laparoscopic surgery with lysis of adhesion. Patient came to ER on 11/19/13 with severe abdominal pain & possible sepsis. Emergency exploratory laparotomy revealed small bowel perforation in distal small bowel & small bowel resection was performed. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Perforated bowel & sepsis. | |||||
| Severity Of Injury | |||||
| Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 2/25/2015 | ||||
| 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 | |||||
| No Payment Made | |||||
| 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 | $13,121 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,877 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Staff education. | |||||||||||||||||||||
| 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 K MEHTA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID K MEHTA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).