| Department File Number : | M201782598 |
| Claim Number : | HPT 1491 |
| Date Submitted : | 7/19/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Fabian, Michael | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-3366100 | ME53577 | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Carol | Wiseheart | |||
| Street Address | |||||
| 747 S. Ridgewood Ave. | |||||
| City | State | Zip | |||
| Daytona Beach | FL | 32114 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (386) 310 - 7969 | (386) 310 - 7973 | cwiseheart@halifaxins.org | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | MICHAEL | FABIAN | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 1890 LPGA Blvd., SUite 250 | ||||
| City | State | Zip Code | County | ||
| Daytona Beach | FL | 32117 | Volusia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 02-179 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME53577 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Volusia | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| HALIFAX MEDICAL CENTER | 100017 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/16/2014 | 12/28/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Hernia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Exploratory laparotomy, lysis of adhesions, component separation with bilateral muscle flap advancement with abdominal wall reconstruction and placement of mesh. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Infection | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 6/15/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Halifax Hospital Medical Center | |||||
| 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 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $237,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $17,000 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,800 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Ongoing Risk Management education. | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 7/19/2017 8:55:32 AM | ||||||
| Reason for Change: | Wrong Disposition date | ||||||
| |||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MICHAEL FABIAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MICHAEL FABIAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).