Department File Number : | M201472850 |
Claim Number : | FP4392501 |
Date Submitted : | 12/4/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6614702 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Muhammad | Amin | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 420 E. Bryd Avenue | ||||
City | State | Zip Code | County | ||
Bonifay | FL | 32425 | Holmes | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-CL099552 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME33481 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Holmes | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
DOCTORS' MEMORIAL HOSPITAL (BONIFAY) | 100078 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Emergency Room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/15/2012 | 1/2/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with flu like symptoms, and was later diagnosed with bacterial meningitis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient admitted for observation and provided supportive care. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Disputed allegations of failure to properly monitor and timely diagnose and treat meningitis. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged cognitive and behavioral deficits | |||||
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 | ||||
3/10/2014 | 14-72CA | ||||
County Suit Filed in | Date of Final Disposition | ||||
Holmes | 11/21/2014 | ||||
Other Defendants Involved in this Claim | |||||
Doctors Memorial Hopsital | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $24,855 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $14,638 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201574358 |
Claim Number : | 137284 |
Date Submitted : | 4/21/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICUS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-5623491 | |||||
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 | Muhammad | Amin | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 420 East Byrd Ave | ||||
City | State | Zip Code | County | ||
Bonifay | FL | 32425 | Holmes | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL16025187 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME33481 | Family Physicians or General Practitioners - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Holmes | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
DOCTORS' MEMORIAL HOSPITAL (BONIFAY) | 100078 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/15/2012 | 5/8/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
acute gastroenteritis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Delay in Diagnosis and Treatment of bacterial meningitis. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Disputed allegation in the delay of diagnosis of bacterial meningitis in this then 3-year-old male resulting in neurological insult. | |||||
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 | ||||
3/10/2014 | 2014-CA-00072 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Holmes | 1/23/2015 | ||||
Other Defendants Involved in this Claim | |||||
Holmes County Hospital | |||||
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 | |||||
12/3/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $215,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $2,145 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,750 | ||||||||||||||||||||
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 met and conferenced with Claims Specialist and Defense Attorney |
Updates | |||||||
Date of Change: | 4/21/2015 2:46:52 PM | ||||||
Reason for Change: | I entered the worng claim number | ||||||
|
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MUHAMMAD AMIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MUHAMMAD AMIN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).