Department File Number : | M201679585 |
Claim Number : | 1034163 |
Date Submitted : | 8/31/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL FIRE & MARINE INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
47-6021331 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Pamela | A | Prudlow | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft. Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0370 | (260) 486 - 0785 | pamela.prudlow@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tomasz | R | Kosowski | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1705 Berglund Lane, Suite 103 | ||||
City | State | Zip Code | County | ||
Viera | FL | 32940 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ES009204 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME120247 | Surgery - Plastic |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Brevard | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Bassin Surgery Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
11/4/2015 | 5/4/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Request for liposuction. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Liposuction. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged negligence in maintaining sterile field. | |||||
Principal Injury Giving Rise To The Claim | |||||
Lead to post-operative infection, surgery to remove necrosis and scarring. | |||||
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 | 8/3/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
After arbitration is initiated or prior to suit being filed. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
7/11/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $49,990 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $5,021 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $4,532 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
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. TOMASZ R KOSOWSKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. TOMASZ R KOSOWSKI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).