Department File Number : | M202091485 |
Claim Number : | 7030129301 |
Date Submitted : | 2/14/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LANDMARK AMERICAN INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
73-0994137 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | James | m | Smith | ||
Street Address | |||||
609 S Willow Ave | |||||
City | State | Zip | |||
Tampa | FL | 33606 | |||
Phone | Ext | Fax | E-Mail Address | ||
(813) 340 - 1079 | drmikemedspa@gmail.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | James | Smith | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 27001 US HWY 19 N Ste 1033 B | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33761 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
LHM835088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME106958 | Emergency Medicine - No Major 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 | ||||
Other Outpatient Facility | Statmed Quick Quality Urgent Care | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | incorrect prescription medication | ||||
Date of Occurrence | Date Reported to Insurer | ||||
11/1/2018 | 12/1/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Urinary Tract Infection | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
patient treated at urgent care for UTI. Pt given incorrect prescription medication. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Patient given an incorrect prescription which resulted in UTI becoming Pyelonephritis. | |||||
Principal Injury Giving Rise To The Claim | |||||
Untreated UTI progressed to Pyelonephritis and the patient was admitted to hospital for IV treatment. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/17/2019 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/17/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Staff education and checks and balances |
Updates | |
No updates found. |
Department File Number : | M202091669 |
Claim Number : | 7030129301 |
Date Submitted : | 2/28/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LANDMARK AMERICAN INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
73-0994137 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jim | Dapolite | |||
Street Address | |||||
945 East Paces Ferry Rd, Suite 1800 | |||||
City | State | Zip | |||
Atlanta | GA | 30326 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 682 - 7683 | (404) 262 - 4437 | jdapolite@rsui.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | James | M | Smith | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 27001 US HWY 19 N Suite 1033 B | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33761 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
LHM835088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME106958 | Emergency Medicine - No Major 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 | ||||
Other Location | Urgent Care Clinic | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Urgent Care Clinic | ||||
Date of Occurrence | Date Reported to Insurer | ||||
11/1/2018 | 11/30/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient went to StatMed Urgent Care due to a urinary tract infection. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient was treated for a urinary tract infection, but was given prescription for incorrect medication. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
The patient was given incorrect medication. | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient was hospitalized due to the prescription error. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/31/2019 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/22/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $885 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Unknown |
Updates | |
No updates found. |
Does Dr. JAMES SMITH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JAMES SMITH, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).