Department File Number : | M201677864 |
Claim Number : | 1028595-02 |
Date Submitted : | 8/11/2016 |
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 | Kathleen | Gordon | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 3001 Hospital Drive | ||||
City | State | Zip Code | County | ||
Cheverly | MD | 20785 | Out of state | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
779433 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME117531 | Radiology - Diagnostic - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | 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 | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/17/2014 | 10/1/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Neck mass with history of trauma | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Read of neck CT | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose tonsillar cancer | |||||
Principal Injury Giving Rise To The Claim | |||||
Growth and expansion of cancer | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/5/2016 | ||||
Other Defendants Involved in this Claim | |||||
Margolin MD, Jerry A | |||||
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 | |||||
4/4/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $17,951 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,217 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $129,808 | ||||||||||||||||||||
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: | 8/11/2016 11:47:03 AM | |||||||||
Reason for Change: | ALE UPDATED 8/11/2016 | |||||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. KATHLEEN GORDON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KATHLEEN GORDON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).