Department File Number : | M201988241 |
Claim Number : | 162526-1 |
Date Submitted : | 1/22/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christina | J | Stoker | ||
Street Address | |||||
2515 PARK PLAZA, BLDG 2-3E | |||||
City | State | Zip | |||
Nashville | TN | 37203 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 1779 | (866) 715 - 7235 | christina.stoker@hcahealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | EDWARD | DJAN-KWANSA | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 6000 49TH STREET NORTH | ||||
City | State | Zip Code | County | ||
SAINT PETERSBURG | FL | 33709 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10116 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS11119 | Emergency Medicine - Including Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
NORTHSIDE HOSPITAL | 100238 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | EMERGENCY ROOM | ||||
Date of Occurrence | Date Reported to Insurer | ||||
11/8/2016 | 9/5/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
COMPLAINTS OF SHARP PAIN IN ABDOMEN THAT HAD STARTED THE PREVIOUS NIGHT. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
BLOOD WORK, CT OF ABDOMEN, ECG DONE FOR EVALUATION. DISCHARGED WITH DIAGNOSIS OF GASTRITIS/EPIGASTRIC PAIN. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
FAILURE TO DIAGNOSE MYOCARDIAL INFARCTION, RESULTING IN VENTRICULAR INJURY. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/6/2017 | 1717-007192-ci | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 2/26/2019 | ||||
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 | |||||
2/8/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $175,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $22,471 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $8,087 | ||||||||||||||||||||
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 | |||||||||||||||||||||
REFERRED TO RISK MANAGEMENT. |
Updates | |
No updates found. |
Does Dr. EDWARD DJAN-KWANSA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. EDWARD DJAN-KWANSA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).