Department File Number : | M201576697 |
Claim Number : | 46529 |
Date Submitted : | 3/28/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 373 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Patrick | K | Williams | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 511 Medical Plaza Dr., Ste. 101 | ||||
City | State | Zip Code | County | ||
Leesburg | FL | 34748 | Lake | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1602418 05 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME77804 | Surgery - Cardiac |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lake | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Florida Heart & Vascular Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/10/2011 | 10/30/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Vascular insufficiency | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Pelvic aortography | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged performance of unnecessary procedure | |||||
Principal Injury Giving Rise To The Claim | |||||
Femoral puncture | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 2/10/2016 | ||||
Other Defendants Involved in this Claim | |||||
The Villages Regional Hospital | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
12/15/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $315,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $52,937 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $13,584 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |||||||
Date of Change: | 3/28/2016 1:48:19 PM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 02/10/16 | ||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. PATRICK K WILLIAMS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. PATRICK K WILLIAMS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).