| Department File Number : | M201573277 |
| Claim Number : | 14-0091-A-12 |
| Date Submitted : | 1/11/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FD INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-3704679 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Tamla | Lloyd | |||
| Street Address | |||||
| 4651 Salisbury Road, Suite 410 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 296 - 2887 | 212 | (904) 296 - 1245 | tlloyd@fdinsurancecompany.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | KHADER | MUQTADIR | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 13905 Bruce B. Downs Blvd., Ste. B | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33613 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MG001081 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME98421 | Surgery - Hand | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | None shown | ||||
| Name of Institution | Code | ||||
| TAMPA BAY HAND CENTER AMBULATORY SURGERY DIVISION | 14960367 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/4/2012 | 5/7/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient underwent an interventional radiology procedure performed by this insured on 2/4/12. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| This insured performed an interventiaonal radiology procedure on the patient's hand. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleging failure to properly monitor and dx compartment syndrome in a timely manner. | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 12/17/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Aird, MD, Cecil | |||||
| 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 | |||||
| 12/17/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $210,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $25,910 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Circumstances of this case have been discussed with insured and risk management was notified. Risk management has discussed case with insured. | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 1/27/2015 10:12:58 AM | ||||||
| Reason for Change: | The Loss Adjusted/Counsel amount was not originally included. | ||||||
| |||||||
| Date of Change: | 1/11/2016 10:13:35 AM | ||||||
| Reason for Change: | Updated LAE amount. | ||||||
| |||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. KHADER MUQTADIR, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KHADER MUQTADIR, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).