Department File Number : | M202091310 |
Claim Number : | 70015 |
Date Submitted : | 1/31/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tonya | Ponder | |||
Street Address | |||||
3535 Piedmont Rd., NE, Bldg. 14 - Ste. 1000 | |||||
City | State | Zip | |||
Atlanta | GA | 30305 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 842 - 5556 | tponder@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ERIC | L | CEITHAML | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2600 Oakgrove Ave. | ||||
City | State | Zip Code | County | ||
Saint Augustine | FL | 32092 | St. Johns | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1603378 02 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME50651 | Surgery - Thoracic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Johns | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/10/2017 | 8/29/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Congenital pulmonary valve stenosis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Pulmonary valve replacement | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged delay in diagnosis and treatment of bilateral compartment syndrome resulting in irreversible muscle damage requiring surgical debridement of all the muscles in the anterior compartments of both of the patient's lower extremities. | |||||
Principal Injury Giving Rise To The Claim | |||||
Foot drop and significant scarring on both lower extremities | |||||
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 | 1/14/2020 | ||||
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 | |||||
1/14/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $65,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $36,029 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $12,909 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured. |
Updates | |
No updates found. |
Does Dr. ERIC L CEITHAML, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ERIC L CEITHAML, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).