Department File Number : | M201573365 |
Claim Number : | 25938-1 |
Date Submitted : | 2/4/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LANCET INDEMNITY RISK RETENTION GROUP INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
26-1479165 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christopher | Teter | |||
Street Address | |||||
2810 West St. Isabel Street Suite 100 | |||||
City | State | Zip | |||
Tampa | FL | 33602 | |||
Phone | Ext | Fax | E-Mail Address | ||
(813) 290 - 8282 | 265 | cteter@lancetindemnity.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Theodor | Von Zielinski | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 271 Riverway Drive | ||||
City | State | Zip Code | County | ||
Vero Beach | FL | 32963 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
LR0911080000855 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME37467 | Surgery - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Hospital/Institution | Indian River Medical Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/6/2011 | 11/26/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Claimant sought treatment for pain in the right lower quadrant of her abdomen. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Claimant alleged the exploratory laparatomy was unnecessary and now has a scar. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
It is alleged that the insured diagnosed a cyst on the ovary that was not actually present. | |||||
Principal Injury Giving Rise To The Claim | |||||
Claimant alleged the exploratory laparatomy was unnecessary and now has a scar. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/13/2013 | 2013-CA-001378 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Indian River | 2/4/2015 | ||||
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 | |||||
10/13/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $57,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $61,328 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurer is unaware of what steps have been taken. |
Updates | |
No updates found. |
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Does Dr. THEODOR VON ZIELINSKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. THEODOR VON ZIELINSKI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).