Department File Number : | M201575799 |
Claim Number : | 1016438-01 |
Date Submitted : | 9/18/2015 |
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 | Myra | J | Lassen | ||
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 | Richard | E | Jackson | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 3191 Harbor Blvd, Suite 2 | ||||
City | State | Zip Code | County | ||
Port Charlotte | FL | 33952 | Charlotte | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
A15409 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Physician Assistant | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA2962 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Manatee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MANATEE MEMORIAL HOSPITAL | 100035 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/31/2012 | 11/12/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Mitral valve prolapse | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Mitral valve replacement surgery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Improper treatment | |||||
Principal Injury Giving Rise To The Claim | |||||
Stitch placed in aorta by surgeon re-operation. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/12/2014 | 2014CA000709 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Manatee | 2/14/2014 | ||||
Other Defendants Involved in this Claim | |||||
Gilman, MD, Alan K Golino MD, Alessandro Riverview Cardiac Surgery PA Alan K Gilman MD PA Lakewood Ranch Anesthesia, PL Manatee Memorial Hospital LP Manatee Memorial Hospital Wellington Regional Medical Center Inc | |||||
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 | |||||
No Payment Made | |||||
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 | $13,816 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |
No updates found. |
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Does Dr. RICHARD E JACKSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RICHARD E JACKSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).