| Department File Number : | M201680547 |
| Claim Number : | 1018942-04 |
| Date Submitted : | 8/17/2017 |
| 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 | Keith | C | Charles | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 12 S Park Ave | ||||
| City | State | Zip Code | County | ||
| Apopka | FL | 32703 | Orange | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 716980 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME69013 | Ophthalmology - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Orange | ||||
| 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 | ||||
| 1/16/2013 | 4/25/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Decreased vision | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Cataract surgery | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Failure to timely do a OCT test before surgery to identify swelling of retina associated with diabetic | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Severe deterioration of visual acuity | |||||
| 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 | ||||
| 9/3/2014 | 14CA1717 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lake | 11/15/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Maizel, Raoul D Pieschke , Glenn | |||||
| 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 | |||||
| Disposed of by Court | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 11/15/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $90,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $21,596 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $6,549 | ||||||||||||||||||||
| 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 | ||||||||||
| Date of Change: | 2/20/2017 3:00:30 PM | |||||||||
| Reason for Change: | ALE UPDATE 2/20/2017 | |||||||||
| ||||||||||
| Date of Change: | 8/17/2017 2:29:37 PM | |||||||||
| Reason for Change: | ALE UPDATE 8/17/2017 | |||||||||
| ||||||||||
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| Department File Number : | M201989935 |
| Claim Number : | 1065383-01 |
| Date Submitted : | 2/25/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL FIRE & MARINE INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 47-6021331 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Michelle | Pierron | |||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Ft Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (800) 463 - 3776 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Keith | Charles | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 17560 US Hwy 441 | ||||
| City | State | Zip Code | County | ||
| Mount Dora | FL | 32757 | Marion | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HN032662 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME69013 | Surgery - Opthalmology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Marion | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Mid Florida Eye Center | ||||
| Name of Institution | Code | ||||
| MID-FLORIDA SURGERY CENTER | 131 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/6/2017 | 8/30/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Vision problems, candidate for multi-focal lenses | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Cataract procedure performed | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged improper cataract procedure | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Permanent vision impairment | |||||
| 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 | ||||
| 1/22/2019 | 83699963 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lake | 8/28/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| The Surgery Center of the Villages LLC Jones, Brian Mid Florida Eye Center Associates | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within 90 days of suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 8/28/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $40,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $10,095 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $40,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| NA | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. KEITH C CHARLES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KEITH C CHARLES, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).