Department File Number : | M201988910 |
Claim Number : | 64912/14 |
Date Submitted : | 5/24/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (404) 842 - 3319 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kimberly | Apple | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 38135 Market Sq | ||||
City | State | Zip Code | County | ||
Zephyrhills | FL | 33542 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1603305 03 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME99795 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pasco | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
Florida Hospital Wesley Chapel | 23960099 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/13/2017 | 12/5/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Cholelithiasis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Laparoscopic cholecystectomy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to note bowel perforation post-op; discharging despite worsening condition | |||||
Principal Injury Giving Rise To The Claim | |||||
Subsequent surgery and stroke | |||||
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 | ||||
4/5/2018 | 2018-CA-000977 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 5/8/2019 | ||||
Other Defendants Involved in this Claim | |||||
Vemuri, MD, Suresh Florida Medical Clinic | |||||
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 | |||||
5/8/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $825,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $14,724 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $13,774 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $200,000 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |
No updates found. |
Department File Number : | M202092326 |
Claim Number : | 69843 |
Date Submitted : | 4/24/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tonya | Ponder | |||
Street Address | |||||
3535 Piedmont Rd., NE, Bldg. 14 - Ste. 1000 | |||||
City | State | Zip | |||
Atlanta | GA | 30305 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 842 - 5556 | tponder@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kimberly | A | Apple | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 38135 Market Square | ||||
City | State | Zip Code | County | ||
Zephyrhills | FL | 33542 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1603305 03 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME99795 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pasco | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
Florida Hospital Wesley Chapel | 23960099 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/2/2016 | 8/15/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with previously identified malignant mass in sigmoid colon. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Laparoscopic colon resection | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged removal of normal portion of colon without ensuring removal of cancer/lesion and failure to inform pt. Pt subsequently died. Alleged 5 month delay in diagnosis of colon cancer. | |||||
Principal Injury Giving Rise To The Claim | |||||
Colon Cancer | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/16/2018 | 2018CA003686CAAXES | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 4/3/2020 | ||||
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 | |||||
4/3/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $600,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,564 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $20,148 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $200,000 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk Management has counseled insured. |
Updates | |
No updates found. |
Does Dr. KIMBERLY APPLE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KIMBERLY APPLE, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).