| Department File Number : | M201987740 |
| Claim Number : | 165219 |
| Date Submitted : | 1/28/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Christina | J | Stoker | ||
| Street Address | |||||
| 1100 Dr. Martin Luther King Jr. Blvd, Ste. 500 | |||||
| City | State | Zip | |||
| Nashville | TN | 37203 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 1779 | (866) 715 - 7235 | christina.stoker@hcahealthcare.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | KENNETH | A | LARSON | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5511 S CONGRESS AVE STE 105 | ||||
| City | State | Zip Code | County | ||
| LAKE WORTH | FL | 33462 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10117 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME88693 | Physicians or Surgeons - Major Surgery. NOC classification. | ||||
| 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 | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| PALMS WEST HOSPITAL | 110006 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | REHABILITATION | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/28/2017 | 7/13/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| PRESENTED WITH COMPLAINTS OF ABDOMINAL PAIN. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| UNDERWENT LAPAROSCOPIC COLECTOMY AND CREATION OF COLOSTOMY. DISCHARGED TO REHAB 7 DAYS LATER. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| MISMANAGEMENT OF STOMA, DEVELOPED INTO INTESTINAL PROLAPSE AND PATIENT 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 | 1/16/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| 1/10/2019 | |||||
| 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 | $5,507 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $200 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| REFERRED TO RISK MANAGEMENT. | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201676795 |
| Claim Number : | 150435-2 |
| Date Submitted : | 1/8/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Teresa | Ross | |||
| Street Address | |||||
| One Park Plaza P.O. Box 555 | |||||
| City | State | Zip | |||
| Nashville | TN | 37202 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | KENNETH | LARSON | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5511 SOUTH CONGRESS AVENUE Suite 105 | ||||
| City | State | Zip Code | County | ||
| Atlantis | FL | 33462 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10113 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME88693 | Surgery - Vascular | 01 | |||
| 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 | ||||
| JFK MEDICAL CENTER | 100080 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/2/2013 | 10/3/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Cholelithiasis. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| During robotic single site cholecystectomy, patient's aorta was perforated. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Perforated aorta, residual scar. | |||||
| 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 | ||||
| 2/17/2015 | 2015-CA-001929 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 12/21/2015 | ||||
| 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 not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $24,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $14,255 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,293 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $21,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Review of policies and procedures. | |||||||||||||||||||||
| Updates | |
| No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
| Department File Number : | M201680478 |
| Claim Number : | 150435-2 |
| Date Submitted : | 11/28/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTH CARE INDEMNITY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 61-0904881 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Teresa | Ross | |||
| Street Address | |||||
| One Park Plaza P.O. Box 555 | |||||
| City | State | Zip | |||
| Nashville | TN | 37202 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | KENNETH | LARSON | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5511 South Congress Avenue Suite 105 | ||||
| City | State | Zip Code | County | ||
| Atlantis | FL | 33462 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCI-10113 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME88693 | Surgery - Vascular | 01 | |||
| 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 | ||||
| JFK MEDICAL CENTER | 100080 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/2/2013 | 10/3/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Cholelithiasis. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| During robotic single site cholecystectomy, patient's aorta was perforated. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Perforated aorta, residual scar. | |||||
| 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 | ||||
| 2/17/2015 | 2015-CA-001929 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 12/21/2015 | ||||
| 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 not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $24,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $14,608 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,295 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $21,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Review of policies and procedures. | |||||||||||||||||||||
| Updates | |
| No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. KENNETH A LARSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KENNETH A LARSON, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).