| Department File Number : | M201574643 |
| Claim Number : | 5147244 |
| Date Submitted : | 8/11/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Susan | K | Spielman | ||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Fort Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0340 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mark | R | Palazzolo | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 13 Neptune Road | ||||
| City | State | Zip Code | County | ||
| Kissimmee | FL | 34744 | Osceola | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 733308 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS10224 | Surgery - Obstetrics - Gynecology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Polk | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| WINTER HAVEN HOSPITAL | 100052 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Labor and Delivery Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/29/2009 | 5/19/2011 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Pregnancy | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Labor and delivery | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Improper treatment | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Shoulder dystocia with Erb's Palsy | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 10/17/2011 | 2011-CA-004966 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Polk | 5/8/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Winter Haven Hospital Inc OB Hospitalist Group LLC | |||||
| 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 | |||||
| Award for defendant. | |||||
| Date of Payment | |||||
| 5/6/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $25,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $62,567 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $25,162 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| N/A | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 8/25/2015 4:54:24 PM | |||||||||
| Reason for Change: | ALE UPDATE | |||||||||
| ||||||||||
| Date of Change: | 1/28/2016 9:57:36 AM | |||||||||
| Reason for Change: | ALE UPDATE 1/28/2016 | |||||||||
| ||||||||||
| Date of Change: | 8/11/2016 11:57:44 AM | |||||||||
| Reason for Change: | ALE UPDATED 8/11/2016 | |||||||||
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Does Dr. MARK R PALAZZOLO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARK R PALAZZOLO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).