| Department File Number : | M201575550 |
| Claim Number : | 35869 |
| Date Submitted : | 9/8/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MAG MUTUAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 58-1449198 | |||||
| Insurer Contact Information | |||||
| Type | Entity Name | ||||
| Entity | MAG MUTUAL INSURANCE COMPANY | ||||
| Street Address | |||||
| 8427 South Park Circle Suite 130 | |||||
| City | State | Zip | |||
| Orlando | FL | 32819 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | MOHAMED | M | FAISAL | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 9981 S. healthpark Dr. Ste. 281 | ||||
| City | State | Zip Code | County | ||
| Fort Myers | FL | 33908 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PRF 1408627 00 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME52201 | Neonatal/Perinatal Medicine | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| LEE MEMORIAL HOSPITAL-HEALTHPARK | 120005 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Nursery | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/28/2009 | 10/19/2010 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Neutropenia and thrombocytopenia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Placement of a radial arterial line | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged failure to properly place and monitor radial arterial line | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Severe gangrene requiring amputation of fingers 2-5 of right hand | |||||
| 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 | ||||
| 7/16/2012 | 12-CA-002155 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lee | 9/1/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Sultan, MD, Shahid Abril, MD, Ivan F Lee Memorial Associates in Neonatology, PA | |||||
| 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 | |||||
| 8/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $33,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $76,860 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $30,229 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Risk management has counseled insured | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 9/8/2015 2:47:51 PM | ||||||
| Reason for Change: | Report udpated to reflect Court Document final disposition date of 09/01/15 | ||||||
| |||||||
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| Department File Number : | M201884813 |
| Claim Number : | PMG-13-AO-263392 |
| Date Submitted : | 3/26/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Pediatrix Medical Group | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 99-9999999 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | MOHAMED | FAISAL | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 9981 HEALTHPARK CR | ||||
| City | State | Zip Code | County | ||
| FORT MYERS | FL | 33908 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PHY-0071-12 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME52201 | Pediatrics - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | CHILDREN'S HOSPITAL OF SOUTHWEST FLORIDA | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/5/2014 | 4/8/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| NEC | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| PRENATAL CARE | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FAILURE TO ORDER X-RAY AND CONTINUING ON ANTIBIOTICS | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DEATH | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/16/2016 | 16-CA-001845 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Lee | 3/26/2018 | ||||
| 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 | |||||
| Disposed of by Court | |||||
| 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? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $12,240 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $215 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. MOHAMED M FAISAL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MOHAMED M FAISAL, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).