Department File Number : | M201989787 |
Claim Number : | 13-005-AB-000428 |
Date Submitted : | 8/21/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE CASUALTY RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1994595 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michelle | Sanscrainte | |||
Street Address | |||||
2850 Golf Road | |||||
City | State | Zip | |||
Rolling Meadows | IL | 60008 | |||
Phone | Ext | Fax | E-Mail Address | ||
(630) 694 - 4264 | (630) 634 - 4634 | mickey_Sanscrainte@ajg.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | EDWARD | W | ST MARY | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 205 East NASA Blvd. | ||||
City | State | Zip Code | County | ||
Melbourne | FL | 32901 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
13-PA-005-AB | $250,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME53713 | Surgery - Orthopedic | BS1495995 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Brevard | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
MELBOURNE SAME-DAY SURGERY | 14960373 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/28/2009 | 8/8/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient reported that his right shoulder had been bothering him for 10 to 15 years. Dr. St. Mary observed moderate crepitation and grinding at his right shoulder. He noted that the patient displayed some weakness during abduction. He noted that pain at the anterior shoulder and mild pain over the anterior AC joint as well. He also documented some pain laterally. He observed that internal or external rotation of the shoulder elicited crepitation and popping but that the patient displayed no evident loss of motion. Dr. St. Mary documented good strength once the patient's right arm was abducted, however, when the patient went from thumbs up to the thumbs down position, moderate discomfort and popping were noted. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Arthroscopic subacromial decompression and bursectomy of the right shoulder; arthroscopic debridement of the glenohumeral joint as well as arthroscopic mumford of the right shoulder. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Injury to the axillary nerve. | |||||
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 | ||||
1/24/2014 | 9505648 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Brevard | 7/9/2019 | ||||
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 | |||||
7/22/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $189,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $138,911 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $50,000 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Hospital Risk Management involved in process. |
Updates | |
No updates found. |
Does Dr. EDWARD W ST MARY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. EDWARD W ST MARY, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).