| Department File Number : | M201782310 |
| Claim Number : | wc/107296-16 |
| Date Submitted : | 6/14/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Watson Clinic LLP | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-070493 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Diane | Szymanski | |||
| Street Address | |||||
| 1600 Lakeland Hills Blvd | |||||
| City | State | Zip | |||
| Lakeland | FL | 33805 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (863) 680 - 7620 | (863) 616 - 2430 | aszymanski@watsonclinic.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Douglas | Shenkman | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 1600 Lakeland Hills Blvd | ||||
| City | State | Zip Code | County | ||
| Lakeland | FL | 33805 | Polk | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PH1605501-PL | $2,000,000 | $18,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME81093 | Surgery - Orthopedic | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Polk | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| Lakeland Regional Medical Center | 100157 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Trauma Unit | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/20/2014 | 8/16/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Multiple life threatening injuries due to a motorcycle accident without use of a helmet. The patient sustained traumatic injuries to the head, face, bilateral hands, and pelvis. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The patient's injuries were caused/sustained due to an during his motorcycle accident and are unrelated to an operation, diagnostic or treatment procedure. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Not applicable. This claim did not involve a misdiagnosis. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Left wrist perilunate dislocation and distal radius fracture. | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 5/18/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 5/18/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $32,839 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $5,300 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstance of event reviewed with individual party involved. | |||||||||||||||||||||
| 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. DOUGLAS SHENKMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DOUGLAS SHENKMAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).