Department File Number : | M201678681 |
Claim Number : | CLFL3114A |
Date Submitted : | 6/8/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CENTURION MEDICAL LIABILITY PROTECTIVE RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1145017 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | LETIA | S | SHELTON | ||
Street Address | |||||
3100 SOUTH GESSNER ROAD SUITE 600 | |||||
City | State | Zip | |||
HOUSTON | TX | 77063 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 353 - 1624 | lshelton@proclaimamerica.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JAMES | WESTERVELT | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 601 7th St S #510 | ||||
City | State | Zip Code | County | ||
ST PETERSBURG | FL | 33701 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL33114 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | GENERAL SURGERY | ||||
License Number | Specialty Code & Classification | Certification Number | |||
ME92565 |
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 Outpatient Facility | |||||
Name of Institution | Code | ||||
BAYFRONT SAME DAY SURGERY CENTER | 226 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/18/2012 | 6/12/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
AXILLARY LYMPH NODE REMOVAL | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
REMOVED INCORRECT AXILLARY LYMPH NODE | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
THERE WASN'T A MISDIAGNOSIS MADE | |||||
Principal Injury Giving Rise To The Claim | |||||
REMOVAL OF INCORRECT AXILLARY LYMPH NODE RESULTING IN SECOND SURGERY | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/22/2015 | ||||
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 | |||||
Award for plaintiff. | |||||
Date of Payment | |||||
9/22/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $700 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $29,773 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $81,000 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Nothing at this time |
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. JAMES WESTERVELT, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JAMES WESTERVELT, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).