Department File Number : | M201783545 |
Claim Number : | 1043356-01 |
Date Submitted : | 8/28/2018 |
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 | Shyam | S | Swain | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 7105 Mariner Blvd | ||||
City | State | Zip Code | County | ||
Spring Hill | FL | 34609 | Hernando | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
629032 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME69790 | Anesthesiology - Pain Management |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hernando | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/13/2015 | 5/9/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Back pain, compression fractures | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
facet injections, advised to seek PCP referral for cement injections | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
failure to treat or refer for treatment of compression fractures | |||||
Principal Injury Giving Rise To The Claim | |||||
lumbar pain, lower extremity pain worsening kyphosis | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/30/2017 | ||||
Other Defendants Involved in this Claim | |||||
Keti Medical & Pain Management | |||||
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 | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/30/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $6,710 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,317 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
Updates | ||||||||||
Date of Change: | 2/13/2018 1:30:14 PM | |||||||||
Reason for Change: | ALE UPDATE 2/13/2018 | |||||||||
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Date of Change: | 8/28/2018 10:56:43 AM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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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. SHYAM S SWAIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SHYAM S SWAIN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).