| Department File Number : | M201781295 |
| Claim Number : | TH-12-LLA-208060-EEA |
| Date Submitted : | 2/27/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| TEAM HEALTH, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 62-1562558 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ERVIN | E | ANTHONY | ||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 368 NE FRANKLIN ST. | ||||
| City | State | Zip Code | County | ||
| LAKE CITY | FL | 32055 | Columbia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 6797264 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME53345 | Emergency Medicine - No Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Columbia | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| SHANDS AT LAKE SHORE | 100102 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/13/2012 | 4/10/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| CLOSED HEAD INJURY | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| SEEN IN ER | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FAILURE TO DIAGNOSE SPINAL EPIDURAL ABSCESS | |||||
| Principal Injury Giving Rise To The Claim | |||||
| PARAPLEGIA | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/28/2013 | 162013CA0080 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Duval | 1/30/2017 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 12/6/2016 | |||||
| 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 | $341,905 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $193,056 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201782402 |
| Claim Number : | PHY-15-329898-1 |
| Date Submitted : | 6/22/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| TEAM HEALTH, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 62-1562558 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ERVIN | E | ANTHONY | ||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 368 NE FRANKLIN ST. | ||||
| City | State | Zip Code | County | ||
| LAKE CITY | FL | 32055 | Columbia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 6797715 | $750,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME53345 | Emergency Medicine - No Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Columbia | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| SHANDS AT LAKE SHORE | 100102 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/12/2015 | 4/1/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| ATTEMPTED SUICIDE | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| SEEN AND EVALUATED | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FAILURE TO IDENTIFY PROLONGED QT | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DEATH | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 7/29/2016 | 2016-CA-5043 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Duval | 5/17/2017 | ||||
| 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 | |||||
| Disposed of by Court | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 1/31/2017 | |||||
| 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 | $24,725 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $9,030 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201989888 |
| Claim Number : | EMC-FL-10A-107285 |
| Date Submitted : | 9/6/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ERVIN | ANTHONY | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 13737 NOEL RD, STE 1600 | ||||
| City | State | Zip Code | County | ||
| DALLAS | TX | 75240 | Out of state | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HAZ1040025381-8 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME53345 | Emergency Medicine - Including Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | SOUTH BAY HOSPITAL | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/2/2010 | 12/6/2010 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| GI BLEED | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| SEEN IN ER | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| ALLEGED FAILURE TO TREAT | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DEATH | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/7/2013 | 13-CA-006038 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 8/9/2019 | ||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 8/6/2019 | |||||
| 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 | $48,708 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $21,936 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. ERVIN E ANTHONY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ERVIN E ANTHONY, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).