Department File Number : | M201783270 |
Claim Number : | 24362-01 |
Date Submitted : | 10/5/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PODIATRY INSURANCE COMPANY OF AMERICA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1403235 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Angeline | Schave | |||
Street Address | |||||
3000 Meridian Blvd. Ste. 400 | |||||
City | State | Zip | |||
Franklin | TN | 37067 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 371 - 8776 | 2998 | (615) 986 - 1945 | aschave@picagroup.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Nicole | Dabul | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 21679 State Road 7 | ||||
City | State | Zip Code | County | ||
Boca Raton | FL | 33428 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1PD0053068 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO3649 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
NORTHWEST MEDICAL CENTER | 100189 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/4/2016 | 9/8/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Plantar Fasciitis; Bilateral calcaneal spurs | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Injection on patient's left heal | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Insured only saw the patient on one visit on 10.15.15 and administered an injection on patient's left heal and instructed patient to follow up in a month. | |||||
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 | 9/27/2017 | ||||
Other Defendants Involved in this Claim | |||||
Davis, Elizabeth A Feit &Goldberg Foot Specialists, P.A. | |||||
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 | |||||
No Payment Made | |||||
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 | $8,836 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Specialty code #80993 |
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. NICOLE DABUL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. NICOLE DABUL, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).