Department File Number : | M201885791 |
Claim Number : | 4340 |
Date Submitted : | 6/28/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Martin Memorial Medical Center, Inc. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-063787 | 4102 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sharon | Laverty | |||
Street Address | |||||
200 Hospital Avenue | |||||
City | State | Zip | |||
Stuart | FL | 34994 | |||
Phone | Ext | Fax | E-Mail Address | ||
(772) 288 - 5899 | sharon.laverty@martinhealth.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | diana | M | chiong | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 200 Hospital Avenue | ||||
City | State | Zip Code | County | ||
Stuart | FL | 34994 | Martin | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
Trust-2016 HPL | $5,000,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS9508 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Lucie | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
TRADITION MEDICAL CENTER | 23960108 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/11/2016 | 2/12/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Stercoral ulcer w/ sigmoid colon perforation | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No operation, diagnostic or treatment procedure caused injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
CT of abdomen | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/14/2017 | 562017CAOO1217AXXXHC | ||||
County Suit Filed in | Date of Final Disposition | ||||
St. Lucie | 6/12/2018 | ||||
Other Defendants Involved in this Claim | |||||
Paragon Services, LLC Diagnostic Imaging Services P.A. U.S. Radiology On-Call, LLC Chang, Daniel T Granada, Gustavo Martin Memorial Medical Center, Inc. | |||||
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 | |||||
6/14/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $50,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $100,000 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Education as indicated |
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. DIANA M CHIONG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DIANA M CHIONG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).