Department File Number : | M201781892 |
Claim Number : | PPLRRG-KH-14-321172 |
Date Submitted : | 4/20/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PHYSICIANS PROFESSIONAL LIABILITY RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
33-1010508 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | KELLY | J | HENSGEN | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 301 MEMORIAL MEDICAL PARKWAY | ||||
City | State | Zip Code | County | ||
DAYTONA BEACH | FL | 32117 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
104266 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS5951 | Family Physicians or General Practitioners - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Volusia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Hospital/Institution | FLORIDA HOSPITAL MEMORIAL MEDICAL CENTER | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | EXAMINATION ROOM | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/3/2014 | 5/7/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
LUNG CANCER | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
FAILURE TO OFFER LUNG CANCER SCREENING | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
FAILURE TO REFER FOR SCREENING | |||||
Principal Injury Giving Rise To The Claim | |||||
METASTATIC LUNG CANCER | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/12/2015 | 2015-31455-CICI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Volusia | 4/20/2017 | ||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
1/10/2017 |
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 | $49,375 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $29,853 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN |
Updates | |
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Does Dr. KELLY J HENSGEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KELLY J HENSGEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).