Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
This page is not displaying certain sensitive information. |
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
This page is not displaying certain sensitive information. |
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
This page is not displaying certain sensitive information. |
Department File Number : | M201884251 |
Claim Number : | 328785 |
Date Submitted : | 2/5/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
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 | Samuel | Bundz | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8112 Centralia Court, Suite 101 | ||||
City | State | Zip Code | County | ||
Leesburg | FL | 34788 | Lake | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1032171 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME76884 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lake | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
LEESBURG REGIONAL MEDICAL CENTER | 100084 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/7/2014 | 4/2/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with abdominal pain and changes in bowel movements. Patient had an umbilical hernia and a right diaphragmatic hernia. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Laparoscopic recurrent incisional hernia repair with extensive adhesiolysis. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Bowel perforation. | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/31/2017 | 2017CA103 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lake | 1/11/2018 | ||||
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 | |||||
1/11/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $5,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $18,833 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,501 | ||||||||||||||||||||
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 : | M201573400 |
Claim Number : | FP4426101 |
Date Submitted : | 2/6/2015 |
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 | Samuel | Bundz | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8112 Centralia Court, Suite 101 | ||||
City | State | Zip Code | County | ||
Leesburg | FL | 34788 | Lake | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-IN026802 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME76884 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Lake | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
LEESBURG REGIONAL MEDICAL CENTER | 100084 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/21/2011 | 5/1/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Cholecystectomy with post-op respiratory abdominal distress. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Exploratory laparotomy with right colectomy and end ileostomy. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Death due to probable aspiration pneumonia of an 84 year old male s/d laparoscopic cholecystectomy and right colectomy with end ileostomy. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/26/2013 | 13 CA 2585 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lake | 2/2/2015 | ||||
Other Defendants Involved in this Claim | |||||
Leesburg Regional Medical Center | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
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 | $28,210 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,488 | ||||||||||||||||||||
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. SAMUEL BUNDZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SAMUEL BUNDZ, MD has at least 5 medical malpractice case(s), lawsuit(s), or complaint(s).