Department File Number : | M202091062 |
Claim Number : | 71536 |
Date Submitted : | 1/10/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tonya | Ponder | |||
Street Address | |||||
3535 Piedmont Rd., NE, Bldg. 14 - Ste. 1000 | |||||
City | State | Zip | |||
Atlanta | GA | 30305 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 842 - 5556 | tponder@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Robert | B | Simpson | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 341 Racetrack Rd., NW, Suite B | ||||
City | State | Zip Code | County | ||
Fort Walton Beach | FL | 32547 | Okaloosa | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1202616 16 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME126140 | Surgery - Orthopedic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Okaloosa | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
FORT WALTON BEACH MEDICAL CENTER | 100223 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/13/2018 | 1/2/2019 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with self inflicted gunshot wound to the right leg | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Prone exploration of traumatic gunshot wound for obvious vascular injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged inadvertent ligation of the popliteal artery during ligation of popliteal vein disruption. | |||||
Principal Injury Giving Rise To The Claim | |||||
Above the knee amputation. | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/18/2019 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
12/18/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $1,000,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $41,176 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,289 | ||||||||||||||||||||
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 | |
No updates found. |
Does Dr. ROBERT B SIMPSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ROBERT B SIMPSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).