Department File Number : | M201781265 |
Claim Number : | F13-0251-12 |
Date Submitted : | 2/21/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sasha | Yamamoto | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2135 | syamamoto@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | William | Kaufman | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8055 Evening Star Lane | ||||
City | State | Zip Code | County | ||
Tallahassee | FL | 32312 | Leon | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS000106 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME30695 | Physicians - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Leon | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physicians Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/1/2012 | 12/9/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to insured for treatment of psoriatic arthritis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No procedure was performed | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose cellulitis | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleging he informed the insured of an open wound on his leg that later became infected leading to the need for extensive debridement of the leg and partial loss of vision | |||||
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 | 12/14/2016 | ||||
Other Defendants Involved in this Claim | |||||
Szczensy, John | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within 90 days of 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 | |||||
12/14/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $300,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $63,132 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of the case have been discussed with the insured and Risk Management |
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 : | M201781544 |
Claim Number : | F13-0251-12 |
Date Submitted : | 3/24/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sash | Yamamoto | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2135 | syamamoto@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | William | P | Kaufman | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 8055 Evening Star Lane | ||||
City | State | Zip Code | County | ||
Tallahassee | FL | 32312 | Leon | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MS000106 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME30695 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Leon | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physicians Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/1/2012 | 12/9/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to insured for treatment of psoriatic arthritis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No procedure was performed | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose cellulitis | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleging he informed insured of an open wound on his leg that later became infected leading to the need for extensive debridement of the leg and partial loss of vision | |||||
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 | 11/15/2016 | ||||
Other Defendants Involved in this Claim | |||||
Szczensy, John | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within 90 days of 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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $300,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $63,134 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstances of the case have been discussed with the insured and Risk Management |
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 KAUFMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILLIAM KAUFMAN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).