Department File Number : | M201990795 |
Claim Number : | WC 118268-19 |
Date Submitted : | 12/9/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Watson Clinic LLP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-0704934 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kimberly | Watkins | |||
Street Address | |||||
1600 Lakeland Hills Blvd | |||||
City | State | Zip | |||
Lakeland | FL | 33805 | |||
Phone | Ext | Fax | E-Mail Address | ||
(863) 680 - 7620 | (863) 616 - 2430 | kwatkins@watsonclinic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Osman | Latif | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1600 Lakeland Hills Blvd | ||||
City | State | Zip Code | County | ||
Lakeland | FL | 33805 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
73113190000-PL | $2,000,000 | $18,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME83327 | Physicians or Surgeons |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Ambulatory Surgery Center | ||||
Name of Institution | Code | ||||
LAKELAND SURGICAL & DIAGNOSTIC CENTER | 278 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/6/2017 | 6/13/2019 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
On 8/25/17, 76-year-old female patient was first seen in Pain Management with complaints of pain in the low back with radiation to the back of the left leg. MRI of the lumbar spine dated 6/25/17 showed multilevel degenerative disk disease which was most severe at L4-L5 level. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
On 9/6/2017, the patient had left side L4 disc epidural lysis of adhesions with RACZ catheter performed at Lakeland Surgical and Diagnostic Center. On 9/7/2017, part 2 of lysis of adhesions was performed using the RACZ catheter that was in place from the previous day. After the completion of the procedure, the catheter was removed. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Surgical or other foreign body retained (Error/Improper performance) | |||||
Principal Injury Giving Rise To The Claim | |||||
On 5/17/2018, the patient subsequently developed a small cyst of the sacral area requiring attention. MRI ordered showed evidence of a magnetic susceptibility artifact within the sacrum and coccyx which was possibly due to retained material from epidural catheter. | |||||
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 | 10/17/2019 | ||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
11/15/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $147,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $8,367 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,925 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Circumstances of the event were reviewed with the individual parties involved. |
Updates | |
No updates found. |
Does Dr. OSMAN LATIF, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. OSMAN LATIF, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).