| Department File Number : | M201575601 |
| Claim Number : | 150479 |
| Date Submitted : | 10/9/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Teresa | Ross | |||
| Street Address | |||||
| One Park Plaza P.O. Box 555 | |||||
| City | State | Zip | |||
| Nashville | TN | 37202 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jeremy | White | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1800 SE Tiffany Avenue | ||||
| City | State | Zip Code | County | ||
| Port Saint Lucie | FL | 34952 | St. Lucie | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10113 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS11193 | Emergency Medicine - No Major Surgery | 01 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | St. Lucie | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| COLUMBIA MED. CTR.-PORT ST. LUCIE | 100260 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Emergency Room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/4/2013 | 10/4/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Respiratory distress. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Allege failure to establish an adequate airway resulting in patient's death. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 2/19/2014 | 562014CA000377 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| St. Lucie | 8/12/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| 7/22/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $68,990 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $32,029 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $100,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Review of policies and procedures. | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 9/15/2015 1:36:24 PM | |||||||||
| Reason for Change: | Additional LAE payments made. | |||||||||
| ||||||||||
| Date of Change: | 10/9/2015 9:45:08 AM | |||||||||
| Reason for Change: | Additional LAE payments made. | |||||||||
| ||||||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. JEREMY WHITE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JEREMY WHITE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).