| Department File Number : | M201472593 |
| Claim Number : | FL-LUN-01 |
| Date Submitted : | 11/7/2014 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 81-0603029 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Julie | Moore | |||
| Street Address | |||||
| 101 E. Park Blvd. | |||||
| City | State | Zip | |||
| Plano | TX | 75074 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (866) 520 - 6896 | jmontague@bpmp.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mauri | Lunderman | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1775 Lewis-Turner Blvd., Suite 102 | ||||
| City | State | Zip Code | County | ||
| Fort Walton Beach | FL | 32547 | Okaloosa | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| I-AMS-115563 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME64728 | Physicians or Surgeons - Major Surgery. NOC classification. | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Okaloosa | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| FORT WALTON BEACH MEDICAL CENTER | 100223 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/29/2006 | 7/27/2010 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Colon cancer of the cecum | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Colonoscopy | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Removal of polyps | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Insured Physician adviosed patient to follow up due to inability to visualize cecum during the procedure. Patient did not follow up and several months later was diagnosed with carcinoma. | |||||
| 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 | ||||
| 12/16/2010 | 10CA6772 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Okaloosa | 8/18/2014 | ||||
| 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 not subject to Arbitration. | |||||
| Date of Payment | |||||
| 4/3/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $102,466 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Monitor for patient follow-up. | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201782596 |
| Claim Number : | FL-LUN-02 |
| Date Submitted : | 7/17/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 81-0603029 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Julie | Moore | |||
| Street Address | |||||
| 101 E. Park Blvd. | |||||
| City | State | Zip | |||
| Plano | TX | 75074 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (866) 520 - 6896 | jmontague@bpmp.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mauri | Lunderman | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1775 Lewis Turner Blvd., Suite 102 | ||||
| City | State | Zip Code | County | ||
| Fort Walton Beach | FL | 32547 | Okaloosa | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| I-AMS-115563 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME64728 | Physicians or Surgeons - Major Surgery. NOC classification. | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Okaloosa | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| FORT WALTON BEACH MEDICAL CENTER | 100223 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/24/2012 | 10/1/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Bowel obstruction and Merkel's diverticulum | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Open appendectomy | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Plaintiff alleged that this Insured Physician failed to examine the bowel during the procedure resulting in further surgery and delayed healing. | |||||
| Severity Of Injury | |||||
| Emotional Only - Fright, no physical damage | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/18/2014 | 2014CA003084 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Okaloosa | 6/29/2017 | ||||
| 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 | |||||
| 2/7/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $99,999 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $22,029 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Complete inspection of bowel during abdominal 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.
| Department File Number : | M201677362 |
| Claim Number : | FL-LUN-03 |
| Date Submitted : | 2/26/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 81-0603029 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Julie | Moore | |||
| Street Address | |||||
| 101 E. Park Blvd. | |||||
| City | State | Zip | |||
| Plano | TX | 75074 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (866) 520 - 6896 | jmontague@bpmp.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mauri | Lunderman | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1775 Lewis-Turner Blvd. | ||||
| City | State | Zip Code | County | ||
| Fort Walton Beach | FL | 32547 | Okaloosa | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| I-AMS-115563 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME64728 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Okaloosa | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| FORT WALTON BEACH MEDICAL CENTER | 100223 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/4/2014 | 7/29/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Cholelithiasis | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Insured Physician performed an open cholecystectomy. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Surgery complete | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Retained foreign object. | |||||
| 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 | 2/24/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| 10/13/2015 | |||||
| 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 | $5,388 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $5,000 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Recheck surgical sponge count. | |||||||||||||||||||||
| 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. MAURI LUNDERMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MAURI LUNDERMAN, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).