Department File Number : | M201887381 |
Claim Number : | FL-ESOW-15 |
Date Submitted : | 12/20/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
81-0603029 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Julie | Moore | |||
Street Address | |||||
101 E. Park Blvd. | |||||
City | State | Zip | |||
Plano | TX | 75074 | |||
Phone | Ext | Fax | E-Mail Address | ||
(866) 520 - 6896 | jmontague@bpmp.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Donald | Montgomery | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 10101 Forest HIll Blvd. | ||||
City | State | Zip Code | County | ||
Wellington | FL | 33414 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
G-AMS-115163 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME71826 | Emergency Medicine - No Major 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 | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
WELLINGTON REGIONAL MEDICAL CENTER | 110010 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/29/2012 | 6/5/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Fetal demise | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
EKG, CT of the chest done to rule out pulmonary embolism | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Shortness of breath, r/o pulmonary embolism | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff alleged Insured Physician failed to monitor fetal heart tones in the ED resulting in fetal demise. | |||||
Severity Of Injury | |||||
Emotional Only - Fright, no physical damage |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/27/2013 | 502013CA016897 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Palm Beach | 11/8/2018 | ||||
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 | |||||
8/30/2018 |
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 | $158,302 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $77,641 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Monitoring of fetal heart tones at all times in ED. |
Updates | |
No updates found. |
Department File Number : | M201473068 |
Claim Number : | FL-ESOW-05 |
Date Submitted : | 12/26/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
81-0603029 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Julie | Moore | |||
Street Address | |||||
101 E. Park Blvd. | |||||
City | State | Zip | |||
Plano | TX | 75074 | |||
Phone | Ext | Fax | E-Mail Address | ||
(866) 520 - 6896 | jmontague@bpmp.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Donald | Montgomery | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 10101 Forest Hill Blvd. | ||||
City | State | Zip Code | County | ||
Wellington | FL | 33414 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
G-AMS-115163 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME71826 | Emergency Medicine - No Major 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 | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
WELLINGTON REGIONAL MEDICAL CENTER | 110010 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/10/2008 | 3/29/2010 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Multi organ failure with anoxic encephalopathy due to DKA | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Lab studies done, medicaitons prescribed. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient returned to ED next morning with severe acidosis and DKA. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/19/2010 | 502010CA018635 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Palm Beach | 12/9/2014 | ||||
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 | |||||
9/5/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $125,872 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Monitor lab values to identify co-morbid conditions and complications |
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. DONALD MONTGOMERY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DONALD MONTGOMERY, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).