| Department File Number : | M201472636 |
| Claim Number : | 1006893-01 |
| Date Submitted : | 1/27/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FLORIDA MEDICAL MALPRACTICE JUA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-1625412 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SUSAN | SPIELMAN | |||
| Street Address | |||||
| 5814 Reed Street | |||||
| City | State | Zip | |||
| Fort Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0340 | (260) 486 - 0782 | SUSAN.SPIELMAN@MEDPRO.COM | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Keith | L | Mullenger | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 111 Viera Drive | ||||
| City | State | Zip Code | County | ||
| Palm Beach Gardens | FL | 33418 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL005809 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME89087 | Radiology - Diagnostic - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| 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 | ||||
| 7/7/2006 | 9/1/2010 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Kidney problems | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Interpreted MRI | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Failure to properly interpret MRI | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Delay in diagnosis and treatment of underlying condition | |||||
| 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 | ||||
| 10/13/2010 | 10-CA-025903 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 11/3/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Jupiter EFL Imaging Center LLC Ortiz MD, Alain Florida United Radiolgy LC | |||||
| 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 | |||||
| 10/31/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $116,791 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $23,696 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $43,000 | ||||||||||||||||||||
| 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: | 1/27/2015 3:59:02 PM | |||||||||
| Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. KEITH L MULLENGER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KEITH L MULLENGER, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).