Department File Number : | M201884270 |
Claim Number : | MS5010301-01 |
Date Submitted : | 2/7/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL SECURITY INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
56-1600780 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Crystal | Mezzullo | |||
Street Address | |||||
700 Spring Forest Road | |||||
City | State | Zip | |||
Raleigh | NC | 27609 | |||
Phone | Ext | Fax | E-Mail Address | ||
(919) 878 - 7617 | (919) 878 - 7617 | crystal.mezzullo@mmicnc.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | DAVID | WINNINGHAM | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 110 Longwood Avenue | ||||
City | State | Zip Code | County | ||
Rockledge | FL | 32955 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ED118876 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS12586 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Brevard | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
WUESTHOFF MEMORIAL HOSPITAL | 23960034 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
9/25/2015 | 7/7/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Alleged TIA | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Seen in emergency department for hyperglycemia and weakness. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose TIA. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged TIA | |||||
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 | 1/9/2018 | ||||
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,102,104 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None needed. |
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 WINNINGHAM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID WINNINGHAM, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).