| Department File Number : | M201883992 |
| Claim Number : | 48976/47606 |
| Date Submitted : | 1/19/2018 |
| 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) 370 - 3813 | (404) 842 - 3319 | ctschanz@magmutual.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Richard | McCauley | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | PO Box 16568 | ||||
| City | State | Zip Code | County | ||
| Jacksonville | FL | 32245 | Duval | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PSL 1603080 00 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME32868 | Surgery - Obstetrics - Gynecology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Clay | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Fleming Island Surgery Center | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/24/2014 | 2/19/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Postmenopausal bleeding | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Hysterectomy/polypectomy | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged failure to use proper surgical technique | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Bowel and uterine perforations | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/13/2015 | 16-2014-CA-007704 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Duval | 1/8/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| N. Fl. OB/GYN LLC Naddap, MD, Naja R N. Fl. Surgeons, PA Brinkman, MD, John D Inpatient Consultants of Florida, Inc. Orange Park Medical Center | |||||
| 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 | |||||
| 12/13/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $400,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $19,908 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $5,258 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Risk management has counseled insured | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 1/19/2018 10:29:37 AM | |||||||||
| Reason for Change: | Report updated to reflect correct date of payment and Court Document of final disposition date | |||||||||
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This page is not displaying certain sensitive information.
| Department File Number : | M201678822 |
| Claim Number : | FP4287101 |
| Date Submitted : | 6/24/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-6614702 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kelly | Andrews | |||
| Street Address | |||||
| 12724 Gran Bay Parkway, W., Suite 400 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Richard | A | McCauley | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1605 Kingsley Avenue | ||||
| City | State | Zip Code | County | ||
| Orange Park | FL | 32073 | Clay | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FP-CL098026 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME32868 | Surgery - Obstetrics - Gynecology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Clay | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| ORANGE PARK MEDICAL CENTER | 100226 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Labor and Delivery Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/17/2012 | 3/21/2012 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| TERM PREGNANCY AND DELIVERY OF IMPAIRED CHILD. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| VAGINAL DELIVERY OF FEMALE INFANT APGARS 8 & 8 DEVELOPED UNEXPECTED AND UNEXPLAINABLE SEIZURE DISORDER. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| FEMALE INFANT WITH SEIZURE DISORDER DETERIORATING TO PROFOUNDLY IMPAIRED. | |||||
| Severity Of Injury | |||||
| Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 5/31/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| NICA | |||||
| 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 | $20,466 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $10,711 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| 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. RICHARD MCCAULEY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RICHARD MCCAULEY, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).