Department File Number : | M201783436 |
Claim Number : | 61163/64 |
Date Submitted : | 10/20/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PROFESSIONAL SECURITY INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-0116462 | |||||
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 | Jane | N | Mai | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4729 N. Habana Ave. | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33614 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ESP 1600063 01 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME116785 | Infectious Diseases - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
SAINT JOSEPH'S HOSPITAL | 100075 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/6/2016 | 2/28/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Epidural abscess | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to timely diagnose and treat epidural abscess | |||||
Principal Injury Giving Rise To The Claim | |||||
Paralysis | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/4/2017 | ||||
Other Defendants Involved in this Claim | |||||
Howell, MD, Matthew D Patel, MD, Sapna Stambo, MD, Glenn W St. Joseph's Hospital Hopkins, DO, Daniel H | |||||
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 | |||||
10/4/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $32,887 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $12,743 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $30,000 | ||||||||||||||||||||
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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. JANE N MAI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JANE N MAI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).