Department File Number : | M201574972 |
Claim Number : | 107-008411 |
Date Submitted : | 6/17/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LEXINGTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-1149494 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kayla | Roberson | |||
Street Address | |||||
17200 West 119th St | |||||
City | State | Zip | |||
Olathe | KS | 66061 | |||
Phone | Ext | Fax | E-Mail Address | ||
(913) 495 - 6578 | Kayla.Roberson@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | R | Gaughen | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2700 University Square Drive | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33612 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
6795717 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME107382 | Radiology - Diagnostic - Minor Surgery |
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 Inpatient Facility | |||||
Name of Institution | Code | ||||
TAMPA GENERAL HOSPITAL | 100128 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/3/2011 | 1/16/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
While undergoing a routine work up for right carotid bruit, plaintiff had an MRA of the neck. Plaintiff was referred to the Dept of Neurosurgery. The neurosurgeon recommended a four-vessel cerebral angiogram to identify the extent of the atherosclerotic carotid and subclavian disease and to confirm the aneurysm. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Cerebral Angiogram was performed. Per the notes, the procedure went without complication. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff has suffered scarring, subsequent skin graft, numbness to her lower right lef, and subsequent surgery. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/30/2013 | ||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $176,571 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. JOHN R GAUGHEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN R GAUGHEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).