Department File Number : | M201677410 |
Claim Number : | FP3951701 |
Date Submitted : | 3/1/2016 |
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 | ROBERT | STATFELD | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1336 Creekside Blvd., Suite 1 | ||||
City | State | Zip Code | County | ||
Naples | FL | 34108 | Collier | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-CL099120 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME48321 | Anesthesiology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Collier | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NORTH COLLIER HOSPITAL | 120006 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/25/2009 | 12/7/2009 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient underwent bilateral sapling-oophorectomy due to family history of cervical cancer. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
IV placement allegedly resulting in infiltration. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Right hand ischemia resulting in amputation of two fingers and pain and limitation of motion of the right hand. | |||||
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 | ||||
4/11/2011 | 11-891-CA | ||||
County Suit Filed in | Date of Final Disposition | ||||
Collier | 9/29/2015 | ||||
Other Defendants Involved in this Claim | |||||
Parker, Ling Tunkle, Aloysha North Collier Hospital Lindner, David Heitmann, Jeffrey | |||||
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 | |||||
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 | $55,797 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $44,371 | ||||||||||||||||||||
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.
Department File Number : | M201679434 |
Claim Number : | 1029877-01 |
Date Submitted : | 2/22/2017 |
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 | ROBERT | A | STATFELD | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1336 Creekside Blvd, Ste 1 | ||||
City | State | Zip Code | County | ||
Naples | FL | 34108 | Collier | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
635947 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME48321 | Anesthesiology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Collier | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NAPLES COMM. HOSPITAL (N. COLLIER) | 100018 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/9/2013 | 12/1/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Mitral valve defect | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Anesthesia for mitral valve repair | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to recognize superior vena cava syndrome | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 8/15/2016 | ||||
Other Defendants Involved in this Claim | |||||
Collier Anesthesia PA | |||||
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 | |||||
Dropped before Action Filed | |||||
Court Decision | Other | ||||
Other | Not Pursued | ||||
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 | $7,552 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,040 | ||||||||||||||||||||
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: | 2/22/2017 10:46:03 AM | |||||||||
Reason for Change: | ALE UPDATE 2/22/2017 | |||||||||
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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. ROBERT STATFELD, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ROBERT STATFELD, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).