| Department File Number : | M201783329 |
| Claim Number : | 7383235928US |
| Date Submitted : | 10/11/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-0687550 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | carolyn | r | ewell | ||
| Street Address | |||||
| 17200 W 119th St | |||||
| City | State | Zip | |||
| Olathe | KS | 66061 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (913) 495 - 4217 | carolynranee.ewell@aig.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | David | Slossberg | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4640 Hypoluxo Road Suite 2 | ||||
| City | State | Zip Code | County | ||
| Lake Worth | FL | 33463 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 019508249 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Chiropractic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| CH8521 | Family Physicians or General Practitioners - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Chiropractor Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/27/2015 | 2/8/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Claimant developed cervical pathology and surgery has been recommended. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The claimant was struck by the device when it flew off the wall striking him in the face, causing whiplash and a laceration to his nose. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Unavailable | |||||
| Principal Injury Giving Rise To The Claim | |||||
| 38 year old male suffered injuries when a traction machine fell onto him during treatment. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 10/10/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 10/10/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $55,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $2,168 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,930 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| N/A | |||||||||||||||||||||
| 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 SLOSSBERG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID SLOSSBERG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).