Department File Number : | M201990747 |
Claim Number : | 71162 |
Date Submitted : | 11/27/2019 |
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 | Gerald | A | Niedzwiecki | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2730 N. McMullen Booth Road, Suite 203 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33761 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1600349 21 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME70649 | Radiology - Diagnostic - Minor 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 | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEASE HOSITAL - COUNTRYSIDE | 110001 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/16/2018 | 11/21/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with pain from a renal calculus that was causing obstructive symptoms. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Percutaneous unilateral nephrolithotomy w/ placement nephrostomy tube with stone fragmentation via an ultrasound lithotripter | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Pt. had an anatomical abnormality as to position of colon and alleged ultrasound would prevent complication. Although not standard of care, a business decision made due to complication of colon perforation. | |||||
Principal Injury Giving Rise To The Claim | |||||
Colon perforation | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/29/2019 | 19-002176-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 9/13/2019 | ||||
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 | |||||
9/13/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $85,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $24,354 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,890 | ||||||||||||||||||||
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. |
Department File Number : | M201782738 |
Claim Number : | 55934 |
Date Submitted : | 9/22/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Gerald | A | Niedzwiecki | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2730 N McMullen Booth Rd Ste 203 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33761 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1600349 18 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME70649 | Radiology - Diagnostic - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEASE HOSPITAL - DUNEDIN | 100043 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/10/2013 | 12/16/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Acute hemoptysis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Bronchial artery embolization | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged excessive use of embolizing agent | |||||
Principal Injury Giving Rise To The Claim | |||||
Embolic stroke, permanent right arm parasthesia | |||||
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 | ||||
5/4/2016 | 16-002947-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 8/14/2017 | ||||
Other Defendants Involved in this Claim | |||||
Mease Hospital | |||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $26,130 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $9,991 | ||||||||||||||||||||
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 | |||||||
Date of Change: | 9/22/2017 2:17:10 PM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 8/14/17 | ||||||
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Does Dr. GERALD A NIEDZWIECKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. GERALD A NIEDZWIECKI, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).