Department File Number : | M201676734 |
Claim Number : | 22466-01 |
Date Submitted : | 1/4/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PODIATRY INSURANCE COMPANY OF AMERICA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1403235 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Karen | Kessler | |||
Street Address | |||||
3000 Meridian Blvd., Suite 400 | |||||
City | State | Zip | |||
Franklin | TN | 37067 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 371 - 8776 | 2249 | kkessler@picagroup.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Thomas | Berens | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 915 Northwest 56th Terrace | ||||
City | State | Zip Code | County | ||
Gainesville | FL | 32605 | Alachua | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1PD0009743 | $500,000 | $1,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO1560 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Alachua | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Name unknown | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/20/2014 | 5/8/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Right hallux valgus deformity with lateral deviation of the hallux | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Bunionectomy with 1st metatarsal osteotomy and 2nd metatarsal osteotomy on the right with arthroplasty at the head of the proximal phalanx of 2nd and 3rd digits, right | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient underwent bunion and hammertoe surgery. Documentation shows patient was non-compliant, and visit after visit she appears without the assistive devices recommended by insured, and her family relates difficulty in trying to keep her inactive. Allegation is non-specific but seems to focus on the migration of a k-wire and the medial displacement of the capital fragment even after surgery. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/17/2015 | ||||
Other Defendants Involved in this Claim | |||||
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 | $16,084 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $750 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None - Specialty code #80993 |
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. THOMAS BERENS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. THOMAS BERENS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).