Department File Number : | M201783337 |
Claim Number : | 330814 |
Date Submitted : | 10/12/2017 |
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 | Sean | M | Mahan | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 5840 Red Bug Lake Road, Suite 185 | ||||
City | State | Zip Code | County | ||
Winter Springs | FL | 32708 | Seminole | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0590968 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME70745 | Radiology - Diagnostic - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Integrative Physician Medicine | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/29/2013 | 6/9/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient underwent ultra sound guided trigger point injection of the right S1 joint. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Trigger point injection of the right S1 joint. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None. | |||||
Principal Injury Giving Rise To The Claim | |||||
Complex regional pain syndrome. | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/30/2015 | 2015-CA-002605 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Seminole | 10/3/2017 | ||||
Other Defendants Involved in this Claim | |||||
Santi, Celestino Ritz, Frank Integrative Physical Medicine of Lake Mary, LLC Integrative Physical Medicine Holding LLC Scheuplein, Bret Ott, Mark Rocker, Jeffry | |||||
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 | $60,278 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11,167 | ||||||||||||||||||||
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. |
This page is not displaying certain sensitive information.
Does Dr. SEAN M MAHAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SEAN M MAHAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).