Department File Number : | M201574144 |
Claim Number : | 2 |
Date Submitted : | 4/6/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Burry, Matthew V | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-5601117 | ME81578 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Matthew | Burry | |||
Street Address | |||||
50 2nd ST SE | |||||
City | State | Zip | |||
Winter Haven | FL | 33880 | |||
Phone | Ext | Fax | E-Mail Address | ||
(863) 594 - 0985 | (863) 294 - 9314 | mvburry@gmail.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Matthew | V | Burry | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 50 @nd Street S.E. | ||||
City | State | Zip Code | County | ||
Winter Haven | FL | 33880 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1 | $1 | $1 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME81578 | Surgery - Neurology - Including Child |
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 | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/8/2008 | 12/10/2008 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
lumbar radiculopathy | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
lumbar laminectomy | |||||
Diagnostic Code : | 724.4 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
patient claims persistent pain | |||||
Severity Of Injury | |||||
Emotional Only - Fright, no physical damage |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/11/2011 | 2011-CA-2820 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 11/8/2014 | ||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
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 | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
none |
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. MATTHEW V BURRY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MATTHEW V BURRY, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).