| Department File Number : | M201680491 |
| Claim Number : | 2016FL182 |
| Date Submitted : | 11/29/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PHYSICIANS CASUALTY RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 27-3867083 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kimberly | Pollick | |||
| Street Address | |||||
| 510 Druid Road, Suite D | |||||
| City | State | Zip | |||
| Clearwater | FL | 33756 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 581 - 6400 | kim@physicianscasualty.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Leroy | Charles | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4849 Lake Worth Road, Suite 201 | ||||
| City | State | Zip Code | County | ||
| Greenacres | FL | 33463 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PCX-2015-486 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME83408 | Surgery - Obstetrics - Gynecology | ||||
| 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 Outpatient Facility | |||||
| Name of Institution | Code | ||||
| WELLINGTON REGIONAL MEDICAL CENTER | 110010 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/19/2014 | 8/24/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment sought for abdominal, pelvic and rectal pain. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Laparoscopic removal of peritoneal foreign body. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Retained surgical needle. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 11/4/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Wellington Regional | |||||
| 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 | |||||
| 11/21/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $4,161 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $35,911 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| None taken as the nurses are in charge of counting the sharps. | |||||||||||||||||||||
| 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. LEROY CHARLES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LEROY CHARLES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).