Department File Number : | M201781913 |
Claim Number : | 1032488-01 |
Date Submitted : | 2/9/2018 |
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 | Raymond | R | Burgess | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 19531 Cochran Blvd | ||||
City | State | Zip Code | County | ||
Port Charlotte | FL | 33948 | Charlotte | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
770236 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS5358 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Charlotte | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/7/2013 | 4/4/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Gynecomastia | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Lab work, ultrasound, medication | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose mass | |||||
Principal Injury Giving Rise To The Claim | |||||
Six month delay in diagnosis leading to increased morbidity | |||||
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 | 4/17/2017 | ||||
Other Defendants Involved in this Claim | |||||
Richardson ARNP, Annmarie Ihnot ARNP, Debra | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
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 | $7,748 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,498 | ||||||||||||||||||||
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 | |||||||||||||||||||||
n/a |
Updates | ||||||||||
Date of Change: | 8/25/2017 1:26:03 PM | |||||||||
Reason for Change: | ALE UPDATE 8/25/2017 | |||||||||
| ||||||||||
Date of Change: | 2/9/2018 2:56:25 PM | |||||||||
Reason for Change: | ALE UPDATE 2/9/2018 | |||||||||
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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. RAYMOND R BURGESS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RAYMOND R BURGESS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).