Department File Number : | M201679276 |
Claim Number : | HOS-MM-121741 |
Date Submitted : | 7/27/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CATLIN SPECIALTY INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
71-6053839 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Denise | LaSorte | |||
Street Address | |||||
3340 Peachtree Road, NE | |||||
City | State | Zip | |||
Atlanta | GA | 30326 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 443 - 5262 | denise.lasorte@xlcatlin.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Thomas | C | Lackey | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 917 Mall Ring Road | ||||
City | State | Zip Code | County | ||
Sebring | FL | 33872 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PLM-202273-0513 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS10031 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Highlands | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
HIGHLANDS REGIONAL MEDICAL CTR. | 100049 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/11/2011 | 9/21/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
lap cholecystectomy | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
lap cholecystectomy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Does not apply. | |||||
Principal Injury Giving Rise To The Claim | |||||
bile leak | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/12/2013 | 13236 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Highlands | 2/17/2015 | ||||
Other Defendants Involved in this Claim | |||||
Highlands Regional Medical Center | |||||
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 | |||||
2/17/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $47,961 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $125,000 | ||||||||||||||||||||
Deductible | $7,500 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201573974 |
Claim Number : | 192160 |
Date Submitted : | 4/16/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PROASSURANCE SPECIALTY INSURANCE COMPANY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3990058 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Denise | Stokes | |||
Street Address | |||||
100 Brookwood Place | |||||
City | State | Zip | |||
Birmingham | AL | 35209 | |||
Phone | Ext | Fax | E-Mail Address | ||
(205) 802 - 4790 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Thomas | C | Lackey | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4751 Lakeview Drive | ||||
City | State | Zip Code | County | ||
Sebring | FL | 33870 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ES1582 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS10031 | Gastroenterology - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Highlands | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/6/2013 | 1/21/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient underwent lap cholecystectomy & expired allegedly due to performance of contraindicated procedure & failure to timely respond to post-op complications | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent lap cholecystectomy & expired allegedly due to performance of contraindicated procedure & failure to timely respond to post-op complications | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient underwent lap cholecystectomy & expired allegedly due to performance of contraindicated procedure & failure to timely respond to post-op complications | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/29/2014 | 14-000412-GCAXMX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Highlands | 2/23/2015 | ||||
Other Defendants Involved in this Claim | |||||
Highlands Regional Medical Center | |||||
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 | |||||
2/24/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,435 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,005 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $100,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insured discussed case with defense counsel, insurance personnel, and medical experts. |
Updates | ||||||||||||||||||||||
Date of Change: | 4/7/2015 3:19:48 PM | |||||||||||||||||||||
Reason for Change: | Financial updates | |||||||||||||||||||||
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Date of Change: | 7/6/2015 11:02:47 AM | |||||||||||||||||||||
Reason for Change: | update ALAE | |||||||||||||||||||||
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Date of Change: | 7/7/2015 10:48:52 AM | |||||||||||||||||||||
Reason for Change: | update ALAE | |||||||||||||||||||||
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Date of Change: | 5/11/2016 4:10:24 PM | |||||||||||||||||||||
Reason for Change: | Updated non economic loss information. | |||||||||||||||||||||
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Date of Change: | 4/16/2018 9:08:33 AM | |||||||||||||||||||||
Reason for Change: | Updated ALAE information | |||||||||||||||||||||
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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.
Department File Number : | M201782195 |
Claim Number : | 198890 |
Date Submitted : | 1/5/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PROASSURANCE SPECIALTY INSURANCE COMPANY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3990058 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Denise | Stokes | |||
Street Address | |||||
100 Brookwood Place | |||||
City | State | Zip | |||
Birmingham | AL | 35209 | |||
Phone | Ext | Fax | E-Mail Address | ||
(205) 802 - 4790 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Thomas | C | Lackey | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4751 Lakeview Drive | ||||
City | State | Zip Code | County | ||
Sebring | FL | 33870 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ES1582 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS10031 | Physicians - Minor Surgery. NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Highlands | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
HIGHLANDS REGIONAL MEDICAL CTR. | 100049 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/26/2013 | 11/7/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Abdominal pain, fever, chills - diagnosed as acute cholecystitis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Laparoscopic exploration with laparoscopic cholecystectomy and lysis of adhesions | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
75 YOM developed bile leak from the cystic duct following a laparoscopic cholecystectomy | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/4/2016 | 2051-000594-GCA | ||||
County Suit Filed in | Date of Final Disposition | ||||
Highlands | 5/30/2017 | ||||
Other Defendants Involved in this Claim | |||||
Florida Lakes Surgical PLLC | |||||
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 | |||||
Dropped before Action Filed | |||||
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 | $55,820 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $19,833 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insured discussed case with defense counsel, insurance personnel, and medical experts. |
Updates | ||||||||||
Date of Change: | 6/6/2017 3:58:03 PM | |||||||||
Reason for Change: | updated ALAE information | |||||||||
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Date of Change: | 1/5/2018 11:33:56 AM | |||||||||
Reason for Change: | Updated ALAE information | |||||||||
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Department File Number : | M201886993 |
Claim Number : | 62574 |
Date Submitted : | 11/13/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PROFESSIONAL SECURITY INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-0116462 | |||||
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 | (404) 842 - 3319 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Thomas | C | Lackey | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4759 Lakeview Dr Ste 101 | ||||
City | State | Zip Code | County | ||
Sebring | FL | 33870 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ESP 1600044 01 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS10031 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Highlands | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
HIGHLANDS REGIONAL MEDICAL CTR. | 100049 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/24/2016 | 6/26/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Repair rectovaginal fistula | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Repair rectovaginal fistula | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to properly perform procedure | |||||
Principal Injury Giving Rise To The Claim | |||||
Transected ureter | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/17/2018 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
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 | $11,783 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $268 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
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 C LACKEY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. THOMAS C LACKEY, MD has at least 4 medical malpractice case(s), lawsuit(s), or complaint(s).