Department File Number : | M202092766 |
Claim Number : | 15-39743 |
Date Submitted : | 6/18/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
THE HEALTHCARE UNDERWRITING COMPANY, A RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-2837805 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Barbara | Stauffer | |||
Street Address | |||||
14201 N. DALLAS PARKWAY | |||||
City | State | Zip | |||
DALLAS | TX | 75254 | |||
Phone | Ext | Fax | E-Mail Address | ||
(469) 893 - 6064 | BARBARA.STAUFFER@TENETHEALTH.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MICHAEL | D | BLACK | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 901 45TH STREET | ||||
City | State | Zip Code | County | ||
WEST PALM BEACH | FL | 33407 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
RRG-2012/13-1 FL | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME110661 | Surgery - Thoracic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
SAINT MARY'S HOSPITAL | 100010 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/16/2013 | 8/27/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
PECTUS EXCAVATUM | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
MODIFIED RIB-SPARING RAVITCH REPAIR | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
NO MISDIAGNOSIS | |||||
Principal Injury Giving Rise To The Claim | |||||
LOOSENING OF HARDWARE, PAIN AND DISCOMFORT AND SCARRING | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/27/2016 | 2016CA008398XXXXMBAO | ||||
County Suit Filed in | Date of Final Disposition | ||||
Palm Beach | 5/8/2020 | ||||
Other Defendants Involved in this Claim | |||||
ST MARYS MEDICAL CENTER | |||||
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 | |||||
3/31/2020 |
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
DR BLACK NO LONGER PRACTICING AT ST MARY'S MEDICAL CENTER |
Updates | |
No updates found. |
Does Dr. MICHAEL D BLACK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MICHAEL D BLACK, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).