Department File Number : | M201883958 |
Claim Number : | 108186 |
Date Submitted : | 1/3/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Diane | M | McNab | ||
Street Address | |||||
4651 Salisbury Road, Ste 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(954) 439 - 0580 | dmcnab@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michael | A | Blum | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 451 SW Bethany Dr | ||||
City | State | Zip Code | County | ||
Port Saint Lucie | FL | 34986 | Martin | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001257 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7680 | Hospitalists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Martin | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MARTIN MEMORIAL MEDICAL CENTER | 100044 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/8/2015 | 12/2/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient presented with pneumonia and a right superficial femoral artery occlusion. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient developed a right superficial femoral artery occlusion and had to undergo four compartment fasciotomies resulting in a foot drop. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
The patient had timely been diagnosed with a right superficial femoral artery occlusion | |||||
Principal Injury Giving Rise To The Claim | |||||
Disputed allegation of the failure to proper monitor and treat a right superficial femoral artery occlusion resulting in additional surgery and foot drop | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/29/2017 | 47-2017-CA000345 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Martin | 12/22/2017 | ||||
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 | |||||
12/20/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $38,089 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $38,089 | ||||||||||||||||||||
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 | |||||||||||||||||||||
insured conferenced with adjuster and attorney as needed |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201781530 |
Claim Number : | F15-0218-A-13 |
Date Submitted : | 3/23/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sasha | Yamamoto | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2135 | syamamoto@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MICHAEL | BLUM | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 451 SW Bethany Drive, Suite 103 | ||||
City | State | Zip Code | County | ||
St. Lucie | FL | 34986 | St. Lucie | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001257 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7680 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Lucie | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Information not provided | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Information not provided | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/10/2013 | 9/15/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Failure to timely follow up on the results of an MRI performed to rule out spinal infection | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
MRI | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Spinal Infection | |||||
Principal Injury Giving Rise To The Claim | |||||
Paraplegia | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/25/2017 | ||||
Other Defendants Involved in this Claim | |||||
Diagnostic Imaging Services, PA Prasad, Tummala | |||||
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 | |||||
Disposed of by Court | |||||
Court Decision | Other | ||||
Summary judgment for the defendant. | |||||
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 | $31,813 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Discussed with insured and Risk Management |
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 : | M201781700 |
Claim Number : | F15-0218-A-13 |
Date Submitted : | 4/5/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dionysia | Lawson | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michael | Blum | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 451 SW Bethany Dr. Ste. 103 | ||||
City | State | Zip Code | County | ||
Port Saint Lucie | FL | 34986 | St. Lucie | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS001257 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7680 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | St. Lucie | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Martin Medical Center | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physician Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/10/2013 | 9/15/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Failure to timely follow up on the results of an MRI performed to rule out spinal infection. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
MRI | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Spinal infection | |||||
Principal Injury Giving Rise To The Claim | |||||
Paraplegia | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/1/2015 | 2015CA012943 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Martin | 1/25/2017 | ||||
Other Defendants Involved in this Claim | |||||
Diagnostic Imaging Services, P.A Prasad, Tummala | |||||
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 | |||||
Disposed of by Court | |||||
Court Decision | Other | ||||
Summary judgment for the defendant. | |||||
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 | $31,813 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Discussed with Insured and Risk Management |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Does Dr. MICHAEL A BLUM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MICHAEL A BLUM, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).