| Department File Number : | M201782968 |
| Claim Number : | 1017048-02 |
| Date Submitted : | 8/21/2018 |
| 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 | T | Agia | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 43309 Us Highway 19 N | ||||
| City | State | Zip Code | County | ||
| Tarpon Springs | FL | 34689 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 763765 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME23403 | Ophthalmology - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | St Lukes Cataract & Laser Institute PA | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/29/2011 | 11/26/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| CATARACTS. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| REMOVAL WITH PLACEMENT OF INTRAOCULAR LENS. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FAILURE TO DIAGNOSE AND TREAT FUNGAL ENDOPHALMITIS. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DECREASED VISION ADDITIONAL SURGERIES | |||||
| 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 | ||||
| 4/16/2014 | 14-002945-CI | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 8/21/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Gills MD, James St Lukes Cataract & Laser Institute PA | |||||
| 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 | |||||
| 8/21/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $175,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $31,648 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $11,297 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $100,000 | ||||||||||||||||||||
| 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: | 9/6/2017 3:03:15 PM | |||||||||
| Reason for Change: | corrected date of report & specialty code | |||||||||
| ||||||||||
| Date of Change: | 1/31/2018 2:22:04 PM | |||||||||
| Reason for Change: | ALE UPDATE 1/31/2018 | |||||||||
| ||||||||||
| Date of Change: | 3/7/2018 4:16:56 PM | |||||||||
| Reason for Change: | correction of policy number | |||||||||
| ||||||||||
| Date of Change: | 8/21/2018 1:10:24 PM | |||||||||
| Reason for Change: | ALE UPDATE | |||||||||
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This page is not displaying certain sensitive information.
| Department File Number : | M201575051 |
| Claim Number : | 1018583 |
| Date Submitted : | 1/28/2016 |
| 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 | Susan | K | Spielman | ||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Fort Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0340 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Raymond | T | Agia | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 43309 US Highway 19 North | ||||
| City | State | Zip Code | County | ||
| Tarpon Springs | FL | 34689 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 763765 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME23403 | Ophthalmology - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | St Luke's Cataract and Laser Institute | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/10/2012 | 4/14/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Loss of vision in right eye | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Vitrectomy | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Failure to diagnose retinal detachment; incorrect procedure | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Diplopia; additional procedures | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 6/15/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| St Luke's Cataract and Laser Institute PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| After arbitration is initiated or prior to suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Disposed of by Arbitration | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Award for defendant. | |||||
| 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 | $41,411 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $19,516 | ||||||||||||||||||||
| 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: | 8/26/2015 9:13:31 AM | |||||||||
| Reason for Change: | ALE UPDATE | |||||||||
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| Date of Change: | 1/28/2016 9:09:54 AM | |||||||||
| Reason for Change: | ALE UPDATE 1/28/2016 | |||||||||
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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 T AGIA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RAYMOND T AGIA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).