Department File Number : | M202092286 |
Claim Number : | 181817264 |
Date Submitted : | 4/21/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
WALLACE, LATOYA M | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-0657322 | PA9109974 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Latoya | M | Wallace | ||
Street Address | |||||
4603 Northmoor Court | |||||
City | State | Zip | |||
Pensacola | FL | 32503 | |||
Phone | Ext | Fax | E-Mail Address | ||
(410) 908 - 7714 | latoyawallace28@yahoo.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Latoya | Wallace | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 4603 Northmoor Court | ||||
City | State | Zip Code | County | ||
Pensacola | FL | 32503 | Escambia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
181817264 | $1,000,000 | $1,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Physician Assistant | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9109974 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Escambia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
GULF BREEZE HOSPITAL | 110003 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/7/2018 | 12/14/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
segmental bowel injury with associated hematoma formation. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
segmental small bowel resection with right and transverse colectomy, evacuation of hematoma and reversal of ileostomy. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None, the patient did not present with abdominal pain or abdominal discomfort at the time of initial evaluation. | |||||
Principal Injury Giving Rise To The Claim | |||||
Segmental bowel injury with associated hematoma formation. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/5/2019 | 0Settlement | ||||
County Suit Filed in | Date of Final Disposition | ||||
Escambia | 12/30/2019 | ||||
Other Defendants Involved in this Claim | |||||
Brantley, Mitchell D Bybee RN, Dawn Richardson, RN , Shannon Baptist Hospital, Inc. d/b/a Gulf Breeze Hospital | |||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
1/10/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $1,000,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $11,247 | ||||||||||||||||||||
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 | |||||||||||||||||||||
The case was settled before the suit was filed. The settlement did not differentiate between non-economic and economic loss. |
Updates | |
No updates found. |
Does Dr. LATOYA WALLACE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LATOYA WALLACE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).