Department File Number : | M202092780 |
Claim Number : | 816440-3 |
Date Submitted : | 6/18/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LONE STAR ALLIANCE, INC., A RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
46-3209483 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | D | King | ||
Street Address | |||||
901 south mopac Blvd V ste 400 | |||||
City | State | Zip | |||
Austin | TX | 78746 | |||
Phone | Ext | Fax | E-Mail Address | ||
(512) 425 - 5940 | (512) 328 - 8067 | john-king@tmlt.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tina | Mize | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 500 Winderley Place, Ste 115 | ||||
City | State | Zip Code | County | ||
Maitland | FL | 32751 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
4-100142 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Physician Assistant | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9107274 | Emergency Medicine - No Major 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 | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
FLORIDA HOSPITAL - APOPKA | 120003 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/14/2016 | 8/31/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
minor patient presented to emergency room after sustaining a right posterior calf laceration secondary to a dirt bike accident | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
reporting clinician cleaned, irrigated and debrided the wound. After applying topical anesthetic gel the wound was sutured. Antibiotic ointment was applied to the wound. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
The patient was brought back to the emergency room 3 days later with complaints of right swollen ankle. Patient was admitted for further workup as an infection was suspected. | |||||
Principal Injury Giving Rise To The Claim | |||||
Following admission, workup determined patient had developed compartment syndrome and underwent several surgeries including fasciotomies and debridement. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/31/2018 | 2018-CA-001027 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 3/25/2020 | ||||
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 | |||||
3/17/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $235,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $106,543 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $86,595 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $235,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
none |
Updates | |
No updates found. |
Does Dr. TINA MIZE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. TINA MIZE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).