Department File Number : | M202092377 |
Claim Number : | 2019025366 |
Date Submitted : | 5/1/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ALLIED WORLD SURPLUS LINES INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
51-0331163 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ashley | Bautista | |||
Street Address | |||||
1690 New Britain Avenue, Suite 101 | |||||
City | State | Zip | |||
Farmington | CT | 06032 | |||
Phone | Ext | Fax | E-Mail Address | ||
(860) 284 - 1502 | Ashley.Bautista@awac.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kenneth | Fortgang | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 10800 Biscayne Boulevard, Suite 810 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33161 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0311-3017 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME43615 | Radiology - Diagnostic - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/10/2018 | 8/15/2019 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Chest pain and shortness of breath | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
CT scan of the chest. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose a pulmonary emboli on Ct scan leading to patient's death. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to diagnose a pulmonary emboli on Ct scan leading to patient's death. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 3/24/2020 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/3/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $3,160 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $500,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Worked closely with counsel to resolve claim. |
Updates | |
No updates found. |
Does Dr. KENNETH FORTGANG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KENNETH FORTGANG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).