Department File Number : | M201884281 |
Claim Number : | 1031203-03 |
Date Submitted : | 8/23/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Olga | Gilman | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 2501 Ortiz Ave | ||||
City | State | Zip Code | County | ||
Fort Myers | FL | 33905 | Lee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
C54109 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Physicians Assistant | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9107444 |
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 Outpatient Facility | |||||
Name of Institution | Code | ||||
SURGICARE CENTER, INC | 60 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/15/2013 | 2/5/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Retrobulbar hemorrhage left | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
emergent lateral left canthotomy & cantholysis, oral & topical steroids, topical & oral ocular hypotensives | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
medical negligence | |||||
Principal Injury Giving Rise To The Claim | |||||
reduced orbital pressure, persistent optic neuropathy with severe vision loss | |||||
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 | ||||
10/14/2016 | 16-CA-003645 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lee | 1/24/2018 | ||||
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 | |||||
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 | $24,117 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $7,399 | ||||||||||||||||||||
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 | |||||||||||||||||||||
n/a |
Updates | ||||||||||
Date of Change: | 8/23/2018 4:15:30 PM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. OLGA GILMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. OLGA GILMAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).