| 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).