Department File Number : | M201783890 |
Claim Number : | 0AB128582 |
Date Submitted : | 12/20/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HOMELAND INSURANCE COMPANY OF NEW YORK | Primary | ||||
Insurer FEIN | Professional License Number | ||||
52-1568827 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mike | Clark | |||
Street Address | |||||
199 Scott Swamp Road | |||||
City | State | Zip | |||
Farmington | CT | 06032 | |||
Phone | Ext | Fax | E-Mail Address | ||
(860) 321 - 2544 | (877) 256 - 5067 | mclark@onebeacon.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MAXIMINA | BOUTSELIS | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 20 Follinsbee Lane | ||||
City | State | Zip Code | County | ||
West Newbury | MA | 01985 | Out of state | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MFL0046440415 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME110153 | Radiology - Diagnostic - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Out of state | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Doctors resdidence | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | doctors residence | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/8/2013 | 5/11/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Broken Wrist | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
x-ray of wrist | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
alleged misdiagnosis of waist of scaphoid bone fracture | |||||
Principal Injury Giving Rise To The Claim | |||||
alleged misdiagnosis of waist of scaphoid bone fracture | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/10/2015 | CACE-15-014245 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 12/19/2017 | ||||
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 | |||||
12/19/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $325,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $45,844 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown at this time. there are also additional co-defendant practitioners involved but we do not have their license data so they were not added on the previous screen |
Updates | |
No updates found. |
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Does Dr. MAXIMINA BOUTSELIS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MAXIMINA BOUTSELIS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).