| Department File Number : | M202092911 |
| Claim Number : | F16-0082-A-14 |
| Date Submitted : | 7/6/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Diane | M | McNab | ||
| Street Address | |||||
| 5555 Gate Parkway, Suite 150 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 33496 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 439 - 0580 | dmcnab@norcal-group.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Devin | Datta | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2222 S Harbor City Blvd | ||||
| City | State | Zip Code | County | ||
| Melbourne | FL | 32901 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG000189 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME82856 | Surgery - Orthopedic | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Brevard | ||||
| 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 | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/17/2014 | 3/16/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient presented to this health care provider with chronic low back pain with progressive lower extremity radicular symptoms for which surgery was scheduled. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| This provider performed a T12-L1, L1-L2, L2-L3, L3-L4 and L4-L5 lumbar discography with radiological interpretation, 5 levels. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Disputed allegation of the failure to timely diagnose and treat a post procedure infection. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Destruction of L1 vertebral body and additional surgery. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/27/2016 | 18th Judicial | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Brevard | 12/18/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/11/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured met and conferenced with defense attorney and claims specialist | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201782662 |
| Claim Number : | F14-0056-A-14 |
| Date Submitted : | 7/24/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Dionysia | Lawson | |||
| Street Address | |||||
| 560 Davis Street | |||||
| City | State | Zip | |||
| San Francisco | CA | 94111 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Devin | Datta | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2222 S. Harbor City Blvd., 6th Floor | ||||
| City | State | Zip Code | County | ||
| Melbourne | FL | 32901 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG000189 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME82856 | Surgery - Orthopedic | ||||
| 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 | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/31/2014 | 3/13/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient presented with complaints of significant right posterolateral buttock pain in the SI joint that radiated into her right leg. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Right sacroiliac joint fusion stabilization. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient had developed right foot drop | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/25/2016 | 05-2016-CA-037481 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Brevard | 6/16/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Gregg, PA-C, Anne Brevard Orthopaedic Spine & Clinic Holmes Regional Medical Center | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 6/16/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $19,651 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstances of the case have been discussed with Risk Management and the insured. | |||||||||||||||||||||
| 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 : | M201574174 |
| Claim Number : | 13-0132-A-10 |
| Date Submitted : | 4/7/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Tamla | N | Lloyd | ||
| Street Address | |||||
| 4651 Salisbury Road, Suite 410 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Devin | Datta | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2222 S. Harbor City Blvd., 6th Floor | ||||
| City | State | Zip Code | County | ||
| Melbourne | FL | 32901 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG000189 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME82856 | Surgery - Orthopedic | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Brevard | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Brevard Orthopaedic Spine & Pain Clinic, | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/15/2010 | 6/11/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Pt was presented to Brevard Orthopaedic Spine & Pain Clinic, Inc. in November, 2010 to undergo surgery to implant a permanent spinal cord stimulator. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Emergent surgery to remove the spinal cord stimulator. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged failure to remove the spinal cord stimulator in a timely manner. Patient developed an infection. | |||||
| 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 | 3/25/2015 | ||||
| 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 | $29,385 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstances of this case have been discussed with the insured and risk management was notified. Risk management has discussed case with insured. | |||||||||||||||||||||
| 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. DEVIN DATTA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DEVIN DATTA, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).