| Department File Number : | M201886748 |
| Claim Number : | 2007-09-200-010 |
| Date Submitted : | 10/16/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Lexington Insurace Company | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-114949 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jessica | Hayden | |||
| Street Address | |||||
| 2985 Drew Street | |||||
| City | State | Zip | |||
| Clearwater | FL | 33764 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 519 - 1268 | jessica.hayden@baycare.org | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | William | Holsonback | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 3001 West Martin Luther King Jr Blvd | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33607 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 390-4900 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME16035 | Surgery - Traumatic | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Taylor | ||||
| 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 | ||||
| 1/14/2005 | 4/18/2007 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Psychiatric admission. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged misdiagnosis of medical conditions which led to anoxic brain injury and death. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Brain Injury and death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 11/13/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| 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 | $44,423 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Any risk issues have been/will be addressed. | |||||||||||||||||||||
| 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 : | M201886873 |
| Claim Number : | 2007-09-200-017 |
| Date Submitted : | 10/29/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| LEXINGTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-114949 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kaye | Monello | |||
| Street Address | |||||
| 2985 Drew Street | |||||
| City | State | Zip | |||
| Clearwater | FL | 33759 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 754 - 9268 | (727) 519 - 1276 | kaye.monello@baycare.org | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | William | D | Holsonback | ||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 3001 West Martin Luther King Jr Blvd | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33607 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 390-4900 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME16035 | Emergency Medicine - No Major 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 | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| SAINT JOSEPH'S HOSPITAL | 100075 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/19/2007 | 7/19/2007 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| ED treatment for abdominal pain | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged misdiagnosis of torn artery | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Need for additional treatment | |||||
| 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 | 11/13/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| 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 | $7,979 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Any risk issues have been addressed. | |||||||||||||||||||||
| 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. WILLIAM HOLSONBACK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILLIAM HOLSONBACK, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).