Department File Number : | M201886635 |
Claim Number : | 109682 |
Date Submitted : | 10/8/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OPHTHALMIC MUTUAL INSURANCE COMPANY (A R.R.G.) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
94-3047990 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | Medical Risk Consultant Group | ||||
Street Address | |||||
PO Box 140457 | |||||
City | State | Zip | |||
Coral Gables | FL | 33114 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 503 - 5704 | (888) 909 - 5304 | MMORENO@MRCG.ORG |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dawn | N | Duss | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 240 Ponte Vedra Park Drive | ||||
City | State | Zip Code | County | ||
Ponte Vedra Beach | FL | 32082 | St. Johns | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
OMC0013191 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME96217 | Surgery - Opthalmology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Surgical Center | ||||
Name of Institution | Code | ||||
JACKSONVILLE BEACH SURGERY CENTER | 14960415 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Operating room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/2/2016 | 11/16/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Elevation deficit | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient evaluated for strabismus. Differential diagnoses included elevator palsy v Brown's syndrome. Intraoperative forced duction was consistent with a diagnosis of Brown's syndrome and surgery to correct the condition was performed. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Postoperatively the patient had worsening hypotropia and revision surgery was performed. | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient had to undergo revision surgery. | |||||
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 | 6/20/2018 | ||||
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 | |||||
9/11/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $400,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Review of medical records with insured and medical experts who were supportive of the medical care and treatment. |
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. DAWN N DUSS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAWN N DUSS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).