| Department File Number : | M201680118 |
| Claim Number : | HOS-MM-160011 |
| Date Submitted : | 10/21/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CATLIN SPECIALTY INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 71-6053839 | |||||
| Insurer Contact Information | |||||
| Type | Entity Name | ||||
| Entity | Catlin Specialty Insurance Co. | ||||
| Street Address | |||||
| 3340 Peachtree Road | |||||
| City | State | Zip | |||
| Atlanta | GA | 30326 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (404) 439 - 6133 | paul.moore@xlcatlin.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Walter | R | Siemian | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 10000 West Colonial Dr., Suite 496 | ||||
| City | State | Zip Code | County | ||
| Ocoee | FL | 34761 | Orange | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| ADM-684266-0316 | $3,000,000 | $10,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME46591 | Surgery - Plastic | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Orange | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | 6900 Turkey Lake Rd | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/28/2015 | 1/28/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Abdominal fat reduction | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Abdominal laser assisted tumescent liposuction | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged unsantiary conditions | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Infection resulting in necrosis of abdominal tissue and extensive debridement of the abdominal and bilateral flank areas | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 8/10/2016 | ||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 8/10/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $2,202,278 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $18,795 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $1,575,446 | ||||||||||||||||||||
| Deductible | $10,000 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Review of sanitary practices | |||||||||||||||||||||
| 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. WALTER R SIEMIAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WALTER R SIEMIAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).