| Department File Number : | M201574890 |
| Claim Number : | 1017401-01 |
| Date Submitted : | 8/26/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Susan | K | Spielman | ||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Fort Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0340 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | JERRY | CHUNG | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1106 Druid Rd South, Ste 302 | ||||
| City | State | Zip Code | County | ||
| Clearwater | FL | 33756 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 751500 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME101742 | Radiology - Diagnostic - Minor 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 | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| MORTON PLANT HOSPITAL | 100127 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/5/2013 | 1/27/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Deep vein thrombosis | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Venogram with stenting | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Improper performance of procedure | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Stenting of veins instead of artery led to occlusion and neurological injury | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/8/2014 | 14-003413CI-13 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 5/20/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Baycare Health System Inc dba Morton Plant Hospital Radiology Associates of Clearwater MD PA Morton Plant Hospital Association Inc dba Morton Plant Hosp | |||||
| 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 | |||||
| 5/18/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $17,211 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $7,519 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $125,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| N/A | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 8/26/2015 9:14:43 AM | |||||||||
| Reason for Change: | ALE UPDATE | |||||||||
| ||||||||||
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| Department File Number : | M201988582 |
| Claim Number : | 1038318-01 |
| Date Submitted : | 9/13/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Lynn | Louthan | |||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Ft Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0778 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jerry | Chung | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1106 Druid Rd S Ste 302 | ||||
| City | State | Zip Code | County | ||
| Clearwater | FL | 33756 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 751500 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME101742 | Radiology - Diagnostic - Minor 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 | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| MORTON PLANT HOSPITAL | 100127 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/2/2016 | 11/17/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Occlusion of the mesenteric artery | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Angiogram | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Unnecessary surgery, failure to recognize brachial arterial sheath hematoma | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Compression of brachial nerve with surgery to decompress and unknown injury to same | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 3/21/2017 | 52 2017 CA 001783 XX | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 4/16/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| Morton Plant Hospital Association Inc dba Morton Plant Hospi Radiology Assoicates of Clearwater MD PA Haydon MD, Allan H Clearwater Surgical Associates PLLC | |||||
| 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 | |||||
| 4/16/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $34,223 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $12,714 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| n/a | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201987495 |
| Claim Number : | 1053632-03 |
| Date Submitted : | 1/3/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Lynn | Louthan | |||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Ft Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0778 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jerry | Chung | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1106 Druid Rd S Ste 302 | ||||
| City | State | Zip Code | County | ||
| Clearwater | FL | 33756 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 751500 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME101742 | Radiology - Diagnostic - Minor 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 | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| MORTON PLANT HOSPITAL | 100127 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/15/2016 | 1/17/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Urosepsis | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| review of chest x-ray to verify placement of a stent | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| failure to report a finding of a retained guidewire | |||||
| Principal Injury Giving Rise To The Claim | |||||
| surgical removal of guide wire, pain and suffering | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/8/2018 | 52-2018-CA-000497 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 12/21/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Benjamin MD, Mark D Halleran MD, William J Squires DO, Jonathan C Howard MD, Robert S Parker MD, Marcus W Greater Florida Anesthesiologists LLC dba Anesthesia Associates of Pinellas Epstein MD, Jay H Bohrmann CRNA, Veronica Morton Plant Hospital Association Inc Bay Area Chest Physicians PA Radiology Associates of Clearwater 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 | |||||
| No Payment Made | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $1,403 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $775 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| n/a | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. JERRY CHUNG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JERRY CHUNG, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).