| Department File Number : | M202092135 |
| Claim Number : | 163039 |
| Date Submitted : | 4/6/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NORCAL MUTUAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 94-2301054 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jessica | Lance | |||
| Street Address | |||||
| P.O. Box 2080 | |||||
| City | State | Zip | |||
| Mechanicsburg | PA | 17055 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 309 - 8129 | jlance@norcal-group.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Diane | L | Cantrell | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1977 Alafaya Trail Ste 1021 | ||||
| City | State | Zip Code | County | ||
| Oviedo | FL | 32765 | Seminole | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 722064N | $100,000 | $300,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor Limited to Mayo Clinic | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME59148 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Seminole | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/23/2015 | 5/3/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Wart on finger | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Laser removal of wart | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| no misdiagnosis made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Necrosis of tip of finger | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 3/15/2019 | 592018CA0027280000 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Seminole | 1/25/2020 | ||||
| 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 | |||||
| 1/30/2020 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $25,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $24,983 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Case discussed with insured, risk management aware of claim | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. DIANE L CANTRELL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DIANE L CANTRELL, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).