Medical Malpractice Cases In Duval County Florida

Dr. JENNY M WHITWORTH Medical Malpractice Lawsuits - Court Case # 2017-CA-002742

Indemnity Paid: $85,000,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201884982
Claim Number :	51502
Date Submitted :	5/21/2018

Insurer Information

Insurer Name				Coverage Type
MAG MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
58-1449198
Insurer Contact Information
Type		Entity Name
Entity		MAG MUTUAL INSURANCE COMPANY
Street Address
8427 South Park Circle Suite 130
City				State	Zip
Orlando				FL	32819
Phone	Ext	Fax	E-Mail Address
(407) 370 - 3813		(404) 842 - 3319	ctschanz@magmutual.com

Insured Information

Type	First Name		MI	Last Name
Individual	Jenny		M	Whitworth
Insurer Type		Street Address of Practice
Licensed		841 Prudential Dr.
City		State	Zip Code	County
Jacksonville		FL	32207	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSL 1603120 01		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME116355		Surgery - Gynecology

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
BAPTIST MEDICAL CENTER SOUTH		23960052
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
9/5/2014		11/19/2014

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Increasing menorrhagia and uterine fibroids
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Hysterectomy and bilateral salpingo-oophorectomy
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform procedure
Principal Injury Giving Rise To The Claim
Perforated duodenal ulcer with peritonitis
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
4/27/2017			2017-CA-002742
County Suit Filed in			Date of Final Disposition
Duval			4/20/2018
Other Defendants Involved in this Claim
Baptist Medical Center Baptist SE Gynecological Oncology Assoc.
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
4/3/2018

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$85,000,000

Loss Adjust Expense Paid to Defense Counsel

$31,600

All Other Loss Adjustment Expense Paid

$7,332

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$588,484	$0
Wage Loss	$0	$400,000
Other Expenses	$0	$200,000

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Risk management has counseled insured

Updates

Date of Change:

5/21/2018 3:58:10 PM

Reason for Change:

Report updated to reflect Court Document final disposition date of 04/20/18

Field Changed	Former Value	New Value
Date of Final Disposition	03-APR-18	20-APR-18

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Dr. LOREN Z CLAYMAN Medical Malpractice Lawsuits - Court Case # 2015-CA-006436

Indemnity Paid: $8,927,189.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201885355
Claim Number :	123456A
Date Submitted :	5/21/2018

Insurer Information

Insurer Name				Coverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)				Primary
Insurer FEIN		Professional License Number
95-3014772
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Kelly			Andrews
Street Address
12724 Gran Bay Parkway, W., Suite 400
City				State	Zip
Jacksonville				FL	32258
Phone	Ext	Fax	E-Mail Address
(904) 360 - 3038			kandrews@thedoctors.com

Insured Information

Type	First Name		MI	Last Name
Individual	Loren		Z	Clayman
Insurer Type		Street Address of Practice
Licensed		2 Shircliff Way Suite 200
City		State	Zip Code	County
Jacksonville		FL	32204	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
123456A		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME23089		Surgery - Plastic

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Other Location		Office Surgical Practice
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury
Other		Office Surgical Practice
Date of Occurrence		Date Reported to Insurer
10/24/2014		5/27/2015

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Elective breast enhancements via placement of saline breast implants.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patients involved in this global settlement underwent at least one elective breast enhancement procedure with placement of saline implants.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Not applicable - elective cosmetic procedures.
Principal Injury Giving Rise To The Claim
After passage of time from their last elective procedure, global plaintiff's alleged concerns with their cosmetic results including concerns over repeat saline implant deflation; a known complication with the use of saline implants.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
10/8/2015			2015-CA-006436
County Suit Filed in			Date of Final Disposition
Duval			3/27/2018
Other Defendants Involved in this Claim
Clayman, MD, Mark A
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

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$8,927,189

Loss Adjust Expense Paid to Defense Counsel

$285,152

All Other Loss Adjustment Expense Paid

$233,842

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Several of the claim were reviewed by medial experts who opined that the rendered care by the insured was in accordance with the standard of care and insurance company staff consulted with insured to discuss preventative measures. Patient safety referral is made if applicable.

Updates

No updates found.

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Dr. CLIFFORD C ARN Medical Malpractice Lawsuits - Court Case # 2004-CA-002145

Indemnity Paid: $5,550,000.00

Medical Malpractice Closed Claims Report

Department File Number :	M200641929
Claim Number :	122592
Date Submitted :	4/4/2008

Insurer Information

Insurer Name				Coverage Type
PROASSURANCE CASUALTY COMPANY				Primary
Insurer FEIN		Professional License Number
38-2317569
Insurer Contact Information
Type		Entity Name
Entity		ProNational Insurance Company
Street Address
13919 Carrollwood Village Run
City				State	Zip
Tampa				FL	33618
Phone	Ext	Fax	E-Mail Address
(813) 969 - 2010		(813) 969 - 2120	SNorris@ProAssurance.com

Insured Information

Type	First Name		MI	Last Name
Individual	CLIFFORD		C	ARN
Insurer Type		Street Address of Practice
Licensed		5500 Blanding Blvd., Suite 1
City		State	Zip Code	County
Jacksonville		FL	32244	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
MP35921		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME55583		Family Physicians or General Practitioners - No Surgery		00000

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Physician's Office
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury

Date of Occurrence		Date Reported to Insurer
2/21/2003		5/6/2003

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Leukopenia with fever, malaise, sore throat and cough.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Symptomatic care and cough medicine for flu type symptoms.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose pneumococcal pneumonia.
Principal Injury Giving Rise To The Claim
Patient who was diagnosed with pneumococcal pneumonia developed septic shock and died.
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
3/19/2004			2004-CA-002145
County Suit Filed in			Date of Final Disposition
Duval			4/10/2006
Other Defendants Involved in this Claim
Arn & Aston, P.A.
Stage of Legal System at which Settlement was Reached or Award Made
During appeal.
Final Method of Claim Disposition
Disposed of by Court
Court Decision			Other
Judgment for the plaintiff.
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/13/2006

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$5,550,000

Loss Adjust Expense Paid to Defense Counsel

$162,756

All Other Loss Adjustment Expense Paid

$135,229

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Insured has dicussed case with insurance company personnel, medical experts and defense counsel.

Updates

Date of Change:

1/5/2007 4:13:59 PM

Reason for Change:

Settlement check was cut on 12/13/06.Also updating expense information.

Field Changed	Former Value	New Value
All Other Loss Adjustment Expense Paid	82033	216496
Indemnity Paid	0	4850000
Settlement Reached	0	1
Amount of Loss Adjustment Expense Paid to Defense Counsel	126882	160899

Date of Change:

3/15/2007 11:46:21 AM

Reason for Change:

Update to reflect change in status and expenses paid.

Field Changed	Former Value	New Value
All Other Loss Adjustment Expense Paid	216496	221136
Indemnity Paid	4850000	5550000
Legal System Stage	After court verdict and prior to filing of notice of appeal.	During appeal.
Amount of Loss Adjustment Expense Paid to Defense Counsel	160899	161281

Date of Change:

5/24/2007 4:01:55 PM

Reason for Change:

Update to reflect additional legal fees and expenses paid.

Field Changed	Former Value	New Value
All Other Loss Adjustment Expense Paid	221136	221529
Amount of Loss Adjustment Expense Paid to Defense Counsel	161281	162704

Date of Change:

9/6/2007 12:00:42 PM

Reason for Change:

Update to reflect reimburse of expenses by reinsurers.

Field Changed	Former Value	New Value
All Other Loss Adjustment Expense Paid	221529	135229

Date of Change:

4/4/2008 11:15:23 AM

Reason for Change:

Report updated to reflect additional legal fees paid.

Field Changed	Former Value	New Value
Amount of Loss Adjustment Expense Paid to Defense Counsel	162704	162756

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Dr. RANDELL POWELL Medical Malpractice Lawsuits - Court Case # 2001-007974-CA

Indemnity Paid: $4,500,000.00

Medical Malpractice Closed Claims Report

Department File Number :	M200955170
Claim Number :	24485-01
Date Submitted :	10/19/2009

Insurer Information

Insurer Name				Coverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INC				Primary
Insurer FEIN		Professional License Number
59-6614702
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Odessa			Choice
Street Address
1000 Riverside Avenue, Suite 800
City				State	Zip
Jacksonville				FL	32204
Phone	Ext	Fax	E-Mail Address
(800) 741 - 3742	3045	(904) 358 - 6728	odessa.choice@fpic.com

Insured Information

Type	First Name		MI	Last Name
Individual	Randell			Powell
Insurer Type		Street Address of Practice
Licensed		836 Prudential Dr, Ste 1105
City		State	Zip Code	County
Jacksonville		FL	32207	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
98307		$500,000		$1,500,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME50450		Surgery - Neurology - Including Child		80152

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
BAPTIST MEDICAL CENTER AND WOLFSON		100088
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
5/26/1999		8/8/2001

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hydrocephalus.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Endoscopic third ventriculostomy.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Severe brain damage.
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
12/7/2001			2001-007974-CA
County Suit Filed in			Date of Final Disposition
Duval			9/28/2009
Other Defendants Involved in this Claim
Baptist Medical Center
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
9/28/2009

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$4,500,000

Loss Adjust Expense Paid to Defense Counsel

$276,594

All Other Loss Adjustment Expense Paid

$192,325

Injured Person's Total Non-Economic Loss

$4,500,000

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Insurance company staff consulted with insured to discuss preventative measures. Risk management referral is made if appropriate.

Updates

No updates found.

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Dr. MARK A CLAYMAN Medical Malpractice Lawsuits - Court Case # 2015-CA-006436

Indemnity Paid: $3,072,811.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201885354
Claim Number :	123456
Date Submitted :	5/21/2018

Insurer Information

Insurer Name				Coverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE)				Primary
Insurer FEIN		Professional License Number
95-3014772
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Kelly			Andrews
Street Address
12724 Gran Bay Parkway, W., Suite 400
City				State	Zip
Jacksonville				FL	32258
Phone	Ext	Fax	E-Mail Address
(904) 360 - 3038			kandrews@thedoctors.com

Insured Information

Type	First Name		MI	Last Name
Individual	Mark		A	Clayman
Insurer Type		Street Address of Practice
Licensed		2 Shircliff Way Suite 200
City		State	Zip Code	County
Jacksonville		FL	32204	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
123456		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME92516		Surgery - Plastic

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Other Location		Office Surgical Practice
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury
Other		Office Surgical Practice
Date of Occurrence		Date Reported to Insurer
10/24/2014		5/27/2015

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Elective breast enhancements via placement of saline breast implants.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patients involved in this global settlement underwent as least one elective breast enhancement procedure with placement of saline implants.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Not applicable - elective cosmetic procedures.
Principal Injury Giving Rise To The Claim
After passage of time from their last elective procedure, global plaintiff's alleged concerns with their cosmetic results including concerns over repeat saline implant deflation; a known complication with the sue of saline implants.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
10/8/2015			2015-CA-006436
County Suit Filed in			Date of Final Disposition
Duval			3/27/2018
Other Defendants Involved in this Claim
Clayman, MD, Loren Z
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

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$3,072,811

Loss Adjust Expense Paid to Defense Counsel

$95,050

All Other Loss Adjustment Expense Paid

$77,947

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Updates

No updates found.

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Dr. SHAILESH K GUPTA Medical Malpractice Lawsuits - Court Case # 2008-CA-015622-MA

Indemnity Paid: $3,013,857.00

Medical Malpractice Closed Claims Report

Department File Number :	M201056247
Claim Number :	06J28658PL-H
Date Submitted :	2/1/2010

Insurer Information

Insurer Name				Coverage Type
Univ of FL JHMHC/Jacksonville Self Insurance Prog				Excess
Insurer FEIN		Professional License Number
59730209
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Danelle		H	Towater
Street Address
3450 Hull Road, Ste 4358
City				State	Zip
Gainesville				FL	32611-2735
Phone	Ext	Fax	E-Mail Address
(352) 273 - 7006		(352) 273 - 7287	towatdt@shands.ufl.edu

Insured Information

Type	First Name		MI	Last Name
Individual	Shailesh		K	Gupta
Insurer Type		Street Address of Practice
Self-Insurer		655 W 8th Street
City		State	Zip Code	County
Jacksonville		FL	32209	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
UFBOT06J-H		$5,000,000		*NR
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME81086		Surgery - Opthalmology

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
UNIVERSITY MEDICAL CENTER (DUVAL)		100001
Location of Institutional Injury		Other Location of Institutional Injury
Critical Care Unit
Date of Occurrence		Date Reported to Insurer
10/21/2006		7/8/2008

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Retinopathy of Prematurity
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Screening premature infant for Retinopathy of Prematurity
Diagnostic Code :		360.26
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Bilateral Blindness
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
12/9/2008			2008-CA-015622-MA
County Suit Filed in			Date of Final Disposition
Duval			4/29/2009
Other Defendants Involved in this Claim
Grover, Sandeep
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
4/29/2009

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$3,013,857

Loss Adjust Expense Paid to Defense Counsel

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Assessment of treatment with physician

Updates

No updates found.

*NR:Prior to 04/28/1999 this field was not required in submitted claims.

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Dr. KASRA A NABIZADEH Medical Malpractice Lawsuits - Court Case # 16-2012-CA-001205

Indemnity Paid: $2,000,000.00

Medical Malpractice Closed Claims Report

Department File Number :	M201367039
Claim Number :	41731/42481
Date Submitted :	6/12/2013

Insurer Information

Insurer Name				Coverage Type
MAG MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
58-1449198
Insurer Contact Information
Type		Entity Name
Entity		MAG MUTUAL INSURANCE COMPANY
Street Address
8427 South Park Circle, Suite 130
City				State	Zip
Orlando				FL	32819
Phone	Ext	Fax	E-Mail Address
(407) 370 - 3813		(407) 370 - 2247	ctschanz@magmutual.com

Insured Information

Type	First Name		MI	Last Name
Individual	Kasra		A	Nabizadeh
Insurer Type		Street Address of Practice
Licensed		11512 Lake Mead Ave., Suite 513
City		State	Zip Code	County
Jacksonville		FL	32258	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSL 1600820 09		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME51611		Internal Medicine - Minor Surgery

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
MEMORIAL HOSPITAL JACKSONVILLE		100179
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
8/5/2010		6/26/2012

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Heparin-induced thrombocytopenia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Prescribed heparin
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged delay in diagnosis and treatment of heparin-induced thrombocytopenia
Principal Injury Giving Rise To The Claim
Bilateral lower extremity amputations
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
10/29/2012			16-2012-CA-001205
County Suit Filed in			Date of Final Disposition
Duval			5/23/2013
Other Defendants Involved in this Claim
Jacksonville Critical Care Southeast Emergency Consultants Bohri Orthopaedic & Sports Medicine Bohsali, MD, Kamal I Jenkins, MD, Frederick L
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
5/3/2013

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$2,000,000

Loss Adjust Expense Paid to Defense Counsel

$24,768

All Other Loss Adjustment Expense Paid

$13,722

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$211,497	$0
Wage Loss	$0	$294,755
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Risk management has counseled insured

Updates

Date of Change:

6/12/2013 12:41:42 PM

Reason for Change:

Report updated to reflect Court Document final disposition date of 05/23/13

Field Changed	Former Value	New Value
Date of Final Disposition	03-MAY-13	23-MAY-13

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Dr. SAFEER A ASHRAF Medical Malpractice Lawsuits - Court Case # 2012-CA-002677

Indemnity Paid: $2,000,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201780852
Claim Number :	41067/39113
Date Submitted :	1/14/2017

Insurer Information

Insurer Name				Coverage Type
MAG MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
58-1449198
Insurer Contact Information
Type		Entity Name
Entity		MAG MUTUAL INSURANCE COMPANY
Street Address
8427 South Park Circle Suite 130
City				State	Zip
Orlando				FL	32819
Phone	Ext	Fax	E-Mail Address
(407) 370 - 3813		(407) 370 - 2247	ctschanz@magmutual.coom

Insured Information

Type	First Name		MI	Last Name
Individual	Safeer		A	Ashraf
Insurer Type		Street Address of Practice
Licensed		9143 Phillips Hwy. Ste. 560
City		State	Zip Code	County
Jacksonville		FL	32256	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSL 1600451 10		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME103831		Hematology - Minor Surgery

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
BAPTIST HOSPITAL		100093
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
2/12/2010		10/19/2011

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Carotid artery clot
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat clot in left internal carotid artery
Principal Injury Giving Rise To The Claim
Brain injury
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
4/25/2012			2012-CA-002677
County Suit Filed in			Date of Final Disposition
Duval			12/19/2016
Other Defendants Involved in this Claim
Sengstock, MD, Charles Pennington, MD, John Naot, MD, Yuval Z Rosemund, MD, R E Namen, MD, Andrew M Baptist Medical Center-South Fernandez, MD, Kristin Beabeau, MD, Eugene ICON
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
12/19/2016

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$2,000,000

Loss Adjust Expense Paid to Defense Counsel

$127,582

All Other Loss Adjustment Expense Paid

$53,525

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$801,678	$9,000,000
Wage Loss	$0	$1,000,000
Other Expenses	$0	$1,000,000

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Risk management has counseled insured

Updates

No updates found.

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Dr. DUKE G PAO Medical Malpractice Lawsuits - Court Case # 16-2015-CA-003619

Indemnity Paid: $2,000,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Department File Number :	M201783186
Claim Number :	54039
Date Submitted :	9/22/2017

Insurer Information

Insurer Name				Coverage Type
MAG MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
58-1449198
Insurer Contact Information
Type		Entity Name
Entity		MAG MUTUAL INSURANCE COMPANY
Street Address
8427 South Park Circle Suite 130
City				State	Zip
Orlando				FL	32819
Phone	Ext	Fax	E-Mail Address
(407) 370 - 3813		(407) 370 - 2247	ctschanz@magmutual.com

Insured Information

Type	First Name		MI	Last Name
Individual	Duke		G	Pao
Insurer Type		Street Address of Practice
Licensed		7758 Burnt Oak Trail
City		State	Zip Code	County
Jacksonville		FL	32256	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSL 1600004 18		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME82560		Radiology - interventional

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Outpatient Facility
Name of Institution		Code
MEMORIAL HOSPITAL JACKSONVILLE		100179
Location of Institutional Injury		Other Location of Institutional Injury
Special Procedure Room
Date of Occurrence		Date Reported to Insurer
10/9/2013		7/21/2015

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Renal cell carcinoma
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Microwave ablation
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform procedure
Principal Injury Giving Rise To The Claim
Urinary system injury
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
10/22/2015			16-2015-CA-003619
County Suit Filed in			Date of Final Disposition
Duval			9/8/2017
Other Defendants Involved in this Claim
Drs. Mori Bean & Brooks Memorial Hospital Neuwave Med. Inc. Crouse, Marlina
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
9/8/2017

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$2,000,000

Loss Adjust Expense Paid to Defense Counsel

$97,267

All Other Loss Adjustment Expense Paid

$35,872

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$479,960
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Risk management has counseled insured

Updates

No updates found.

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Dr. NAM PHUONG T LU Medical Malpractice Lawsuits - Court Case # 2006-CA-003552

Indemnity Paid: $1,900,000.00

Medical Malpractice Closed Claims Report

Department File Number :	M200952973
Claim Number :	23787
Date Submitted :	3/18/2009

Insurer Information

Insurer Name				Coverage Type
MAG MUTUAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
58-1449198
Insurer Contact Information
Type		Entity Name
Entity		MAG MUTUAL INSURANCE COMPANY
Street Address
8427 South Park Circle Suite 130
City				State	Zip
Orlando				FL	32819
Phone	Ext	Fax	E-Mail Address
(407) 370 - 3813		(407) 370 - 2247	cwehner@magmutual.com

Insured Information

Type	First Name		MI	Last Name
Individual	NAM PHUONG		T	LU
Insurer Type		Street Address of Practice
Licensed		11512 Lake Mead Ave. #513
City		State	Zip Code	County
Jacksonville		FL	32256	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSL 1600820 03		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
OS8549		Internal Medicine - No Surgery

Medical Malpractice Closed Claims Report

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	Duval
City			State	Zip Code

Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
SAINT LUKES' HOSPITAL		100151
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
10/20/2003		12/27/2005

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Aseptic meningitis
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Brain stem herniation following LP
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to order appropriate administration and monitoring of Dilaudid
Principal Injury Giving Rise To The Claim
Progressive respiratory failure
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

Legal Information

Date of Suit			Circuit Court Case Number
5/12/2006			2006-CA-003552
County Suit Filed in			Date of Final Disposition
Duval			2/23/2009
Other Defendants Involved in this Claim
Martinez-Bejar, MD, Lucia M
Stage of Legal System at which Settlement was Reached or Award Made
During trial, but before court verdict.
Final Method of Claim Disposition
Settled by parties
Court Decision			Other
Directed verdict for plaintiff.
Arbitration
Claim not subject to Arbitration.
Date of Payment
2/5/2009

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$1,900,000

Loss Adjust Expense Paid to Defense Counsel

$183,117

All Other Loss Adjustment Expense Paid

$183,999

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Risk management has counseled insured

Updates

No updates found.

This page is not displaying certain sensitive information.

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Aaron Metcalf

Aaron Metcalf PA
1514 Landon Ave
Jacksonville, FL 32207-8655

904-598-0293

http://metcalflaw.com