| Department File Number : | M201574797 |
| Claim Number : | 14-0145-A-12 |
| Date Submitted : | 1/19/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Tamla | Lloyd | |||
| Street Address | |||||
| 4651 Salisbury Road, Suite 410 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | HOI | DO | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5907 Webb Road | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33615 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 11929 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME45208 | Physicians - Minor Surgery. NOC classification. | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Weight and Body Solutions, LLC | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Weight and Body Solutions, LLC | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/20/2012 | 7/11/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| On or about September 20, 2012, pt was presented to Weight and Body Solutions, LLC for treatment of liposuction by insd. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Liposuction | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The liposuction procedure allegedly caused irregularities, fat necrosis, uneven scar tissue, holes and indentations. | |||||
| Severity Of Injury | |||||
| Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/19/2014 | 2014-CA-005180 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 5/6/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Weight and Body Solutions, LLC | |||||
| 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 | |||||
| 5/6/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $92,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $10,962 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstances of this case have been discussed with the insured and risk management was notified. Risk management has discussed case with the insured. | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 1/19/2016 3:34:59 PM | ||||||
| Reason for Change: | Updated LAE amount. | ||||||
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Does Dr. HOI DO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. HOI DO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).