Department File Number : | M201885299 |
Claim Number : | 160958-2 |
Date Submitted : | 5/14/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christina | J | Stoker | ||
Street Address | |||||
1100 Charlotte Ave, Ste 500 | |||||
City | State | Zip | |||
Nashville | TN | 37203 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 1779 | (615) 344 - 5889 | christina.stoker@hcahealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MARK | V | WARD | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 11375 CORTEZ BLVD | ||||
City | State | Zip Code | County | ||
SPRING HILL | FL | 34613 | Hernando | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10116 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | PHYSICIAN ASSISTANT | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9108536 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hernando | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
OAK HILL HOSPITAL | 100264 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | EMERGENCY ROOM | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/6/2016 | 3/23/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
HEADACHE, NECK PAIN AND PHOTOPHOBIA. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
ALLEGED FAILURE TO DIAGNOSE MENINGITIS. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
N/R | |||||
Principal Injury Giving Rise To The Claim | |||||
MENINGITIS | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/17/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $10,076 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,686 | ||||||||||||||||||||
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 | |||||||||||||||||||||
REVIEW OF POLICIES AND PROCEDURES. |
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. MARK V WARD, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARK V WARD, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).