Department File Number : | M201472419 |
Claim Number : | 1005528-01 |
Date Submitted : | 1/27/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FLORIDA MEDICAL MALPRACTICE JUA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-1625412 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | SUSAN | SPIELMAN | |||
Street Address | |||||
5814 Reed Street | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | (260) 486 - 0782 | SUSAN.SPIELMAN@MEDPRO.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jay | E | Olsson | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 401 N Wickham Road, Ste S | ||||
City | State | Zip Code | County | ||
Melbourne | FL | 32935 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL005157 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS4087 | Physical Medicine and Rehabilitation - Pain Management |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Brevard | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
HOLMES REGIONAL MEDICAL CENTER | 100019 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/16/2008 | 4/11/2009 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Headaches | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Office exam and prescription of Decadron | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to taper patient off Decadron | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/9/2009 | 2009-CA-59437 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Brevard | 10/13/2014 | ||||
Other Defendants Involved in this Claim | |||||
University of Florida Board of Trustees Healthsouth of Sea Pines Rehabilitation Hospital Shenoy MD, Sachin R Grenevicki MD, Lance F Holmes Regional Medical Center Inc Sachin R Shenoy MD PA | |||||
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 | |||||
10/9/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $134,167 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $139,055 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $36,937 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $120,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 1/27/2015 3:55:42 PM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. JAY E OLSSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JAY E OLSSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).