Department File Number : | M201676979 |
Claim Number : | 107-021875 |
Date Submitted : | 2/1/2016 |
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 | Desmond | Smith | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1526 SE 47th Street | ||||
City | State | Zip Code | County | ||
Cape Coral | FL | 33904 | Lee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
018586613 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Chiropractic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
CH2884 | Physicians or Surgeons |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
CAPE CORAL SURGERY CENTER | 14960614 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Chiropractor | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/18/2013 | 2/10/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
61 y/o female alleging medical negligence resulting in fracture. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Problems w/right leg. The pain was located in the right buttock and the area between the right upper thigh and mid calf. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
61 y/o female alleging medical negligence resulting in fracture. | |||||
Principal Injury Giving Rise To The Claim | |||||
61 y/o female alleging medical negligence resulting in fracture. | |||||
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 | 2/1/2016 | ||||
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 | $2,303 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,879 | ||||||||||||||||||||
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. DESMOND SMITH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DESMOND SMITH, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).