Department File Number : | M201886749 |
Claim Number : | 2012-08-444-004 |
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 | XIAOMING | WAN | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 300 Park Place Blvd #170 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33759 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
112-37-063 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME87645 | Internal Medicine - No 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 | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physican's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
11/25/2012 | 12/27/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with flu symptoms and was treated. The next day his wife called the office and asked for a doctor¿s release from work note for 3 more days because he wasn¿t feeling better. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The following day the patient was admitted for acute renal failure, hepatitis and possible endocarditis. It was discovered he had been using IV drugs. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
It is alleged that the MD was negligent for not seeing the patient and only providing a doctor¿s excuse form. The patient expired.. There were no direct allegations against the group and no payment was made on behalf of the group. This is being reported due to legal expenses are greater than $5,000 | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/21/2016 | ||||
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 | $19,219 | ||||||||||||||||||||
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.
Does Dr. XIAOMING WAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. XIAOMING WAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).