| Department File Number : | M201783595 |
| Claim Number : | 96665 |
| Date Submitted : | 12/1/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICUS INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-5623491 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Diane | M | McNab | ||
| Street Address | |||||
| 4651 Salisbury Road | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 439 - 0580 | dmcnab@norcal-group.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mark | D | Dixon | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 12479 Telecom Drive | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33637 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL-16030904 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME63074 | Emergency Medicine - No Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| FLORIDA HOSPITAL (ORLANDO) | 100007 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/30/2013 | 8/11/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| acute left leg contusion and acute left knee sprain | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| failing to timely diagnose and treat tibia fracture | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Thirty year old female alleges failure to timely diagnose and treat tibia fracture resulting in compartment syndrome and four compartment fasciotomy. | |||||
| 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 | ||||
| 5/29/2015 | 15-003449-CI | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 10/13/2017 | ||||
| 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 | |||||
| 11/2/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $30,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $49,640 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $49,640 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured met and conferenced with adjuster and attorney. | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 12/1/2017 3:35:29 PM | |||||||||
| Reason for Change: | Updated since my summary page indicated it was "incomplete". This was a resubmission. | |||||||||
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Does Dr. MARK D DIXON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARK D DIXON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).