| Department File Number : | M201678345 |
| Claim Number : | 156608 |
| Date Submitted : | 3/17/2017 |
| 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 | Jesse | Klein | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1345 West Bay Drive Suite 101 | ||||
| City | State | Zip Code | County | ||
| Largo | FL | 33770 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10114 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS10628 | Cardiovascular Disease - Minor Surgery | 01 | |||
| 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 Outpatient Facility | |||||
| Name of Institution | Code | ||||
| LARGO MEDICAL CENTER | 100248 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/7/2014 | 10/14/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Rule out coronary artery anomaly. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient underwent arterial cardiac catheterization. The next day, patient developed severe right leg pain. Patient had ultrasound done which indicated deep vein thrombosis of right femoral vein. Vascular surgeon ultimately found large hematoma in right anterior thigh compressing right femoral vein, causing occlusion. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DVT right femoral vein, occlusion of vein, hematoma. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 4/20/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| 4/14/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $650,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $32,528 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $13,872 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $400,000 | ||||||||||||||||||||
| 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: | 3/17/2017 3:14:36 PM | |||||||||
| 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. JESSE KLEIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JESSE KLEIN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).