Department File Number : | M201782251 |
Claim Number : | 2016-08-901-002 |
Date Submitted : | 6/8/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Lexington Insurace Company | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-114949 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | Hayden | |||
Street Address | |||||
2985 Drew Street | |||||
City | State | Zip | |||
Clearwater | FL | 33764 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 519 - 1268 | jessica.hayden@baycare.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Gregory | Marolf | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 2985 Drew Street | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33759 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
120-73-195 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME76645 | Internal Medicine - No 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 | ||||
Other Location | BayCare Urgent Care | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | BayCare Urgent Care | ||||
Date of Occurrence | Date Reported to Insurer | ||||
5/1/2016 | 12/2/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient diagnosed with epididymititis, due to tenderness and firmness over the epididymis. Patient was later diagnosed with testicular torsion. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Alleged failure to diagnose testicular torsion | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose testicular torsion | |||||
Principal Injury Giving Rise To The Claim | |||||
Testicular tortion resulting in loss of testicle. | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/20/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/20/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $19,615 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Any risk issues have been/will be addressed. |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. GREGORY MAROLF, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. GREGORY MAROLF, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).