| Department File Number : | M201782660 |
| Claim Number : | 37131-1 |
| Date Submitted : | 7/24/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| LANCET INDEMNITY RISK RETENTION GROUP INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 26-1479165 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Christopher | Teter | |||
| Street Address | |||||
| 2810 West St. Isabel Street Suite 100 | |||||
| City | State | Zip | |||
| Tampa | FL | 33602 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (813) 290 - 8282 | 265 | cteter@lancetindemnity.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | William | Capo | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 6101 WEBB ROAD SUITE 106 | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33615 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| LR091296001337 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME68087 | Cardiovascular Disease - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | Tampa Community Hospital | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/14/2014 | 11/26/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment was sought for pain in left neck and shoulder. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Claimant had a septic shoulder and underwent surgery. A cardiology consult was requested post surgery but the TEE machine was not working. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged improper discharge of a patient prior to securing a working TEE. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/16/2016 | 16-CA-011472 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 6/23/2017 | ||||
| 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 | |||||
| 6/23/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $50,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $21,420 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insurer is unaware of what steps have been taken. | |||||||||||||||||||||
| 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.
| Department File Number : | M201574633 |
| Claim Number : | 2009-31-01-00035 |
| Date Submitted : | 5/14/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PHYSICIANS INDEMNITY RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-5245060 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jaclyn | S | Adler | ||
| Street Address | |||||
| 9300 NW 14th Street | |||||
| City | State | Zip | |||
| Pembroke Pines | FL | 33024 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 559 - 3131 | (954) 431 - 8388 | Jadjuster2@aol.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | WILLIAM | CAPO | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 6101 Webb Road Suite 106 | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33614 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PIR 10056 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME68087 | Cardiovascular Disease - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| SAINT JOSEPH'S HOSPITAL | 100075 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/17/2008 | 7/8/2009 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Ischemic bowel/sepsis | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| There was no operation, diagnostic, or treatment procedure rendered that caused an injury. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged failure to timely diagnose and treat ischemic bowel resulting in death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 3/25/2010 | 10-006135 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 2/27/2015 | ||||
| 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 | |||||
| 2/27/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $20,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $52,962 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $20,000 | ||||||||||||||||||||
| 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. |
This page is not displaying certain sensitive information.
Does Dr. WILLIAM CAPO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILLIAM CAPO, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).