Department File Number : | M201885507 |
Claim Number : | CORP-14-287912 |
Date Submitted : | 6/8/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
TEAM HEALTH, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
62-1562558 | |||||
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 | PATRICIA | H | SPISAK-DIAL | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 9401 SW DISCOVERY WAY, SUITE 103 | ||||
City | State | Zip Code | County | ||
STUART | FL | 34987 | St. Lucie | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
6797715 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Nurse Practitioner | ||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP2822282 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Martin | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
MARTIN MEMORIAL HOSPITAL SOUTH | 120009 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/19/2014 | 4/14/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
INJURY TO LOWER LEGS | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEEN IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
FAILURE TO PROPERLY TREAT | |||||
Principal Injury Giving Rise To The Claim | |||||
SCARRING | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 6/8/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
5/22/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $10,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $14,883 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,778 | ||||||||||||||||||||
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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. PATRICIA H SPISAK-DIAL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. PATRICIA H SPISAK-DIAL, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).