Department File Number : | M201472123 |
Claim Number : | 5149035-01 |
Date Submitted : | 8/25/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Susan | K | Spielman | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | William | J | Halleran | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1106 Druid Road South, Ste 302 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33756 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
571499 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME86155 | Radiology - Diagnostic - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEASE HOSPITAL - DUNEDIN | 100043 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/11/2011 | 4/19/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Hip pain from fall | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
ER exam and X-rays | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Missed fracture of hip | |||||
Principal Injury Giving Rise To The Claim | |||||
Pain and suffering; worsening of symptoms | |||||
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 | ||||
11/14/2012 | 12-13094-CI-11 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 9/9/2014 | ||||
Other Defendants Involved in this Claim | |||||
Trustees of Mease Hospital Inc dba Mease Dunedin Hospital Radiology Associates of Clearwater MD PA | |||||
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 | |||||
Award for plaintiff. | |||||
Date of Payment | |||||
9/8/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $22,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $24,104 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $12,018 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $22,500 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 2/13/2015 11:22:35 AM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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Date of Change: | 8/25/2015 5:01:09 PM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. WILLIAM J HALLERAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILLIAM J HALLERAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).