| Department File Number : | M201574750 |
| Claim Number : | 50686 |
| Date Submitted : | 7/16/2015 |
| 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 | (407) 370 - 2247 | ctschanz@magmutual.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SANJAY | H | NAVADIA | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 11373 Cortez Blvd. Ste. 206 | ||||
| City | State | Zip Code | County | ||
| Brooksville | FL | 34613 | Hernando | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PSL 1602746 03 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME86903 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Pasco | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| OAK HILL HOSPITAL | 100264 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/26/2011 | 9/4/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Metastatic renal cell carcinoma | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| No iatrogenic injury | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged failure to follow-up on abnormal CT demonstrating hydronephrosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Metastatic renal cell carcinoma | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/27/2015 | 512015CA000252 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pasco | 6/22/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Hernando Pasco Primary Care Funderburk, MD, Jason G Nortel Medical Staffing | |||||
| 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 | |||||
| 5/11/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $16,274 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $4,779 | ||||||||||||||||||||
| 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: | 7/16/2015 12:02:31 PM | ||||||
| Reason for Change: | Report updated to reflect Court Document final disposition date of 06/22/15 | ||||||
| |||||||
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| Department File Number : | M201678000 |
| Claim Number : | MM272799 |
| Date Submitted : | 4/20/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EVANSTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2950161 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | CRYSTAL | L | ALSTONBAYTON | ||
| Street Address | |||||
| 4600 COX ROAD | |||||
| City | State | Zip | |||
| GLEN ALLEN | VA | 23060 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (804) 864 - 3731 | (855) 662 - 7535 | CALSTONBAYTON@MARKELCORP.COM | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SANJAY | H | NAVADIA | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 11373 CORTEZ BLVD; SUITE 206 | ||||
| City | State | Zip Code | County | ||
| BROOKSVILLE | FL | 34613 | Hernando | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MM824237 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME86903 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Hernando | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| OAK HILL HOSPITAL | 100264 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/21/2014 | 9/25/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| CLMT PRESENTED TO OAK HILLS HOSPITAL WHERE HIS PCP ADMITTED HIM WITH CHIEF COMPLAINT OF ABDOMINAL PAIN FOR 5-6 DAYS PRIOR TO VISIT. DIAGNOSED WITH BILIARY COLIC. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| CLMT PRESENTED TO OAK HILLS HOSPITAL WHERE HIS PCP ADMITTED HIM WITH CHIEF COMPLAINT OF ABDOMINAL PAIN FOR 5-6 DAYS PRIOR TO VISIT. DIAGNOSED WITH BILIARY COLIC. DR ORDERED FURTHER STUDIES AND A SURGICAL CONSULT FOR A LAPAROSCOPIC CHOLECYESTECTOMY. A RECOMMENDATION WAS MADE FOR A CT SCAN OF THE ABDOMEN AND ALPHA FETOPROTEIN TO RULE OUT NEOPLASTIC PROCESS IN THE LIVER. AFTER REVIEWING CT SCAN, DR FUNDERBURK SUGGESTED AN ULTRASOUND D/T A NEW LEFT HYDRONEPHROSIS REQUESTING THE RESULTS BE CALLED TO THE NURSE OR PHYSICIAN. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| CLMT ALLEGES FAILURE TO DIAGNOSE RENAL CELL CARCINOMA | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Florida suit against Insured's contract physician Dr. Jason Funderburk alleging failure to note left renal mass on May 26, 2011 CT, resulting in delayed diagnosis of renal cell carcinoma first made during September 3, 2013 admission, resulting in death of 57 y/o Claimant from metastatic renal cell carcinoma on February 26, 2014. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/27/2015 | 512015ca000252ca | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pasco | 2/22/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| HERNANDO PASCO PRIMARY CARE LLC NORTEK MEDICAL STAFFING INC FUNDERBURK, JASON G | |||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| Other | DISMISSAL WITH PREJUDICE | ||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 9/4/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $175,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $62,399 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $10,215 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $15,000 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| None | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. SANJAY H NAVADIA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SANJAY H NAVADIA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).