Department File Number : | M201575136 |
Claim Number : | 36183 |
Date Submitted : | 7/9/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Univ of FL JHMHC Self-Insurance Program | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-600205 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Merry | C | Reid | ||
Street Address | |||||
201 S. E. Second Avenue, Suite 208 | |||||
City | State | Zip | |||
Gainesville | FL | 32601 | |||
Phone | Ext | Fax | E-Mail Address | ||
(352) 273 - 7006 | (352) 273 - 5424 | REIDM@ufl.edu |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michael | S | Nussbaum | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 580 W. Eighth Street | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32209 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
UFBOT13J | $300,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME101904 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
UNIVERSITY MEDICAL CENTER (DUVAL) | 100001 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/27/2013 | 4/21/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Acute/chronic cholecystitis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Robotic-assisted laparoscopic cholecystectomy w/intraoperative cholangiogram, excision of a choledochal cyst, choledochodudenostomy, and excision of a supraclavicular lipoma | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Bile leak s/p procedure with damage to hepatic artery and bowel | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 6/23/2015 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
6/23/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $300,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $383 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Assessment of treatment with physician |
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.
Does Dr. MICHAEL S NUSSBAUM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MICHAEL S NUSSBAUM, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).