| Department File Number : | M201680571 |
| Claim Number : | SHI-15R-323861 |
| Date Submitted : | 12/9/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | DONALD | BLAKE | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1613 NORTH HARRISON PARKWAY #200 | ||||
| City | State | Zip Code | County | ||
| SUNRISE | FL | 33323 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HAZ 4032218126-0 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME106078 | Radiology - Diagnostic - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | JUPITER OPEN IMAGING | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | RADIOLOGY | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/4/2015 | 12/28/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| cardiac defects | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| FETAL ULTRASOUND | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FAILURE TO RECOGNIZE | |||||
| Principal Injury Giving Rise To The Claim | |||||
| BIRTH DEFECTS | |||||
| 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 | ||||
| 4/13/2016 | XXX111 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 12/9/2016 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 11/4/2016 | |||||
| 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 | $43,781 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $7,973 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| unknown | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201783695 |
| Claim Number : | SHI-17R-JV-362777-2 |
| Date Submitted : | 11/21/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | DONALD | C | BLAKE | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1613 NORTH HARRISON PARKWAY | ||||
| City | State | Zip Code | County | ||
| SUNRISE | FL | 33213 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HAZ 4032218126-2 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME106078 | Radiology - Diagnostic - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | JUPITER OPEN IMAGING | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/2/2013 | 3/7/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| MAMMOGRAM | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| MAMMOGRAM | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| DELAY IN DIAGNOSIS | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DELAY SURGERY | |||||
| 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 | ||||
| 6/19/2017 | XXXX111 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 10/27/2017 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 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 | $27,740 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $17,509 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
Does Dr. DONALD BLAKE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DONALD BLAKE, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).