Department File Number : | M201473074 |
Claim Number : | 26236-1 |
Date Submitted : | 12/30/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LANCET INDEMNITY RISK RETENTION GROUP INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
26-1479165 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christopher | Teter | |||
Street Address | |||||
2810 West St. Isabel Street Suite 100 | |||||
City | State | Zip | |||
Tampa | FL | 33602 | |||
Phone | Ext | Fax | E-Mail Address | ||
(813) 290 - 8282 | 265 | cteter@lancetindemnity.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | DeCosmo | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 4800 4th Street North | ||||
City | State | Zip Code | County | ||
Saint Petersburg | FL | 33703 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
LR091188000705 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS5534 | Internal Medicine - No 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 | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physician Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/23/2010 | 12/21/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with wheezing and ultimately had lung cancer. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Routine physical exam was performed. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose lung cancer. | |||||
Principal Injury Giving Rise To The Claim | |||||
Death. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/29/2013 | 13-7616-CL | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 12/30/2014 | ||||
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 | |||||
9/19/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $35,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $32,745 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurer is unaware of what steps have been taken. |
Updates | |
No updates found. |
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Does Dr. JOHN DECOSMO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN DECOSMO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).