Medical Malpractice Cases

Medical Malpractice Cases In Okaloosa County Florida

Dr. Claben Rey Barraca Medical Malpractice Lawsuits - Court Case # 2016-CA-001027F

Indemnity Paid: $1,000,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201782234
Claim Number : 155400-2
Date Submitted : 4/13/2018
 
Insurer Information
 
Insurer Name Coverage Type
HEALTH CARE INDEMNITY, INC. Primary
Insurer FEIN Professional License Number
61-0904881  
Insurer Contact Information
Type First Name MI Last Name
Individual Teresa   Ross
Street Address
One Park Plaza P.O. Box 555
City State Zip
Nashville TN 37202
Phone Ext Fax E-Mail Address
(615) 344 - 5804     Teresa.Ross@HCAHealthcare.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualClaben Rey Barraca
Insurer TypeStreet Address of Practice
Licensed100 Mar-Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
HCI-10113$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME92836Psychiatry - All Other01

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
8/30/20136/10/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Postpartum depression, anxiety, suicide attempt.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Allege patient was prematurely discharged & sent home with a prescription for too high a dose of Ambien, along with allegations that physician failed to properly assess & treat patient for suicidal ideation brought on by postpartum depression.
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Suicide.
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
3/23/20162016-CA-001027F
County Suit Filed inDate of Final Disposition
Okaloosa5/18/2017
Other Defendants Involved in this Claim
 
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
5/4/2017
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$1,000,000
Loss Adjust Expense Paid to Defense Counsel$201,505
All Other Loss Adjustment Expense Paid$53,873
Injured Person's Total Non-Economic Loss$925,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$150,000
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Review of policies and procedures.
 
Updates
 
 
Date of Change:4/13/2018 9:55:30 AM
Reason for Change:Additional LAE payments made.
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel140791201505
All Other Loss Adjustment Expense Paid2601453873

 

 

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

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Dr. John F Huhn Medical Malpractice Lawsuits - Court Case # 03CA8384

Indemnity Paid: $850,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432146
Claim Number :00-16521
Date Submitted :7/26/2004
 
Insurer Information
 
Insurer NameCoverage Type
CLARENDON NATIONAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
52-0266645 
Insurer Contact Information
TypeFirst NameMILast Name
IndividualNancy  Thomas
Street Address
2000 West Sam Houston Parkway South, 19th Floor; One Briarlake Plaza
CityStateZip
HoustonTX77042-361
PhoneExtFaxE-Mail Address
(713) 935 - 8868 (713) 461 - 8130nancy_thomas@ajg.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJohnFHuhn
Insurer TypeStreet Address of Practice
Licensed7251 University Blvd.Suite 300
CityStateZip CodeCounty
Winter ParkFL32792Orange
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
CMP0005832$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME61564Surgery - Laryngology 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOrange
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
  
Date of OccurrenceDate Reported to Insurer
4/11/20019/7/2001
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Large mass involving sphenoid sinus in the surrounding structures
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Bilateral endoscopicsphenoidotomy on outpatient basis
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
Alleged that upon awakening from procedure, the patient complained of vision loss in left eye and very shortly thereafter, total blindness.
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/23/200303CA8384
County Suit Filed inDate of Final Disposition
Okaloosa6/28/2004
Other Defendants Involved in this Claim
Montoya, German
Florida Otolaryngology Group, PA
Orlando Neurosurgical Associates, P.A.
German Montoya, M.D., P.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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
7/14/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$850,000
Loss Adjust Expense Paid to Defense Counsel$18,240
All Other Loss Adjustment Expense Paid$5,205
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$0$0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Unknown
 
Updates
 
No updates found.

 

 

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Dr. David W Burkland Medical Malpractice Lawsuits - Court Case # 2003 CA 003661 S

Indemnity Paid: $725,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200432386
Claim Number :17606
Date Submitted :8/5/2004
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813  cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualDavidWBurkland
Insurer TypeStreet Address of Practice
Licensed1005 MAR WALT DR
CityStateZip CodeCounty
FORT WALTON BEACHFL32547-6707Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
FL 15715Physicians - Minor Surgery.NOC classification.330368503

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/2/20014/22/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Suspected primary splenic lymphoma
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Splenectomy
Diagnostic Code :571.5
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose cirrhosis and portal hypertension
Principal Injury Giving Rise To The Claim
Bleeding
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
9/12/20032003 CA 003661 S
County Suit Filed inDate of Final Disposition
Okaloosa8/5/2004
Other Defendants Involved in this Claim
 
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/5/2004
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$725,000
Loss Adjust Expense Paid to Defense Counsel$32,813
All Other Loss Adjustment Expense Paid$0
Injured Person's Total Non-Economic Loss$725,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$100,000$0
Wage Loss$6,000$900,000
Other Expenses$2,000$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. Wayne E Campbell Medical Malpractice Lawsuits - Court Case # 04-CA-1786-C-JT

Indemnity Paid: $650,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200639933
Claim Number :18846
Date Submitted :3/16/2006
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualWayneECampbell
Insurer TypeStreet Address of Practice
Licensed550 REDSTONE AVE W STE 200
CityStateZip CodeCounty
CRESTVIEWFL32536-6429Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600515 01$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME30203Internal Medicine - No Surgery1103

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Other Outpatient FacilityCampbell Crestview Medical Clinic
Name of InstitutionCode
  
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
5/19/200210/21/2003
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Intermittent chest pain
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
EKG, prescribed Bextra
Diagnostic Code :428.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to hospitalize patient
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
4/27/200404-CA-1786-C-JT
County Suit Filed inDate of Final Disposition
Okaloosa2/17/2006
Other Defendants Involved in this Claim
Crestview Medical Clinic, 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
2/28/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$650,000
Loss Adjust Expense Paid to Defense Counsel$10,902
All Other Loss Adjustment Expense Paid$11,532
Injured Person's Total Non-Economic Loss$650,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$0$0
Other Expenses$4,975$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. Joseph A Pedone Medical Malpractice Lawsuits - Court Case # 13-003278-CA

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201573845
Claim Number : 43987
Date Submitted : 5/4/2015
 
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
 
TypeFirst NameMILast Name
IndividualJosephAPedone
Insurer TypeStreet Address of Practice
Licensed129 E. Redstone Ave. Ste. A
CityStateZip CodeCounty
CrestviewFL32539Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1601320 08$1,000,000$3,000,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME82012Cardiovascular Disease - Minor Surgery 

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Operating Suite 
Date of OccurrenceDate Reported to Insurer
12/20/201012/15/2013
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Single vessel disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Placement of MYNX closure device
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to properly perform procedure
Principal Injury Giving Rise To The Claim
Occlusion and left leg 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 SuitCircuit Court Case Number
7/17/201313-003278-CA
County Suit Filed inDate of Final Disposition
Okaloosa4/23/2015
Other Defendants Involved in this Claim
Zarate, MD, Juan C
Okaloosa Cardiology
Ft. Walton Beach 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/16/2015
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$30,773
All Other Loss Adjustment Expense Paid$8,239
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$1,351,994$2,554,980
Wage Loss$0$181,000
Other Expenses$0$17,552
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:5/4/2015 1:16:14 PM
Reason for Change:Report updated to reflect 4/23/15
 
Field ChangedFormer ValueNew Value
Date of Final Disposition16-MAR-1523-APR-15

 

 

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Dr. Gilberto L Vigo Medical Malpractice Lawsuits - Court Case # pre-suit1

Indemnity Paid: $500,000.00

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201678058
Claim Number : 209228
Date Submitted : 10/29/2018
 
Insurer Information
 
Insurer Name Coverage Type
PROASSURANCE INDEMNITY COMPANY, INC. Primary
Insurer FEIN Professional License Number
63-0720042  
Insurer Contact Information
Type First Name MI Last Name
Individual Denise   Stokes
Street Address
100 Brookwood Place
City State Zip
Birmingham AL 35209
Phone Ext Fax E-Mail Address
(205) 802 - 4790   (205) 802 - 4710 claimscompliancereporting@proassurance.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualGilbertoLVigo
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
MP83249$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME65239Internal Medicine - No Surgery 

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Physician's Office 
Name of InstitutionCode
N/A000000
Location of Institutional InjuryOther Location of Institutional Injury
OtherPhysican's office
Date of OccurrenceDate Reported to Insurer
1/27/201412/16/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Intractable migraine headaches
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Medicated with prednisone
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Does not apply
Principal Injury Giving Rise To The Claim
Plaintiff alleges prescribing of chronic used steroids for treatment of migraine headaches resulted in bilateral hip necrosis, adrenal insufficiency and osteopenia.
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 SuitCircuit Court Case Number
1/4/2016pre-suit1
County Suit Filed inDate of Final Disposition
Okaloosa4/19/2016
Other Defendants Involved in this Claim
White-Wilson Medical Center, PA
Stage of Legal System at which Settlement was Reached or Award Made
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed).
Final Method of Claim Disposition
Settled by parties
Court DecisionOther
No Court Proceedings. 
Arbitration
Claim subject to arbitration, but settlement reached in lieu of award.
Date of Payment
 
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$12,251
All Other Loss Adjustment Expense Paid$2,951
Injured Person's Total Non-Economic Loss$500,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
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 discussed care with defense cousel, insurance personnel, and medical experts.
 
Updates
 
 
Date of Change:5/5/2016 1:26:13 PM
Reason for Change:Updated Co-defendent info and diagnosis information.
 
Field ChangedFormer ValueNew Value
Final DiagnosisPatient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOIIntractable migraine headaches
Cause of InjuryPatient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOIMedicated with prednisone
Principal InjuryPatient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOIPlaintiff alleges prescribing of chronic used steroids for treatment of migraine headaches resulted in bilateral hip necrosis, adrenal insufficiency and osteopenia.
MisdiagnosisPatient w/severe, intractable, chronic migraines & episodes of sudden syncope underwent 2-year course of high dose steroids, was diagnosed w/ osteopenia and severe avascular necrosis of hips. NOIDoes not apply
No Other Defendants10
Defendant Entity Name White-Wilson Medical Center, PA
 
Date of Change:5/12/2016 4:56:02 PM
Reason for Change:Updated indemnity amount
 
Field ChangedFormer ValueNew Value
Injured Person Total Non-Economic Loss0500000
Indemnity Paid0500000
Settlement Reached01
 
Date of Change:6/2/2016 2:57:06 PM
Reason for Change:updated ALAE amoutns
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid16882705
Amount of Loss Adjustment Expense Paid to Defense Counsel445510292
 
Date of Change:7/8/2016 3:32:11 PM
Reason for Change:updated ALAE amounts
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid27052712
Amount of Loss Adjustment Expense Paid to Defense Counsel1029210346
 
Date of Change:2/16/2018 12:03:37 PM
Reason for Change:Updated ALAE information
 
Field ChangedFormer ValueNew Value
All Other Loss Adjustment Expense Paid27122951
Amount of Loss Adjustment Expense Paid to Defense Counsel1034611881
 
Date of Change:7/10/2018 1:28:21 PM
Reason for Change:updated alae
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel1188112085
 
Date of Change:9/26/2018 12:58:09 PM
Reason for Change:updated alae
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel1208512187
 
Date of Change:10/29/2018 1:17:11 PM
Reason for Change:updated alae
 
Field ChangedFormer ValueNew Value
Amount of Loss Adjustment Expense Paid to Defense Counsel1218712251

 

 

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Dr. Robert L Rogers Medical Malpractice Lawsuits - Court Case # 05-CA-4249

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M200851541
Claim Number :21040/21041
Date Submitted :4/1/2009
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247cwehner@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRobertLRogers
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32548Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 03$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME41071Surgery - Thoracic4812

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
12/9/200311/8/2004
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Post-operative intraabdominal infection
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
No iatrogenic injury
Diagnostic Code :799.9
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose and treat post-operative intraabdominal infection
Principal Injury Giving Rise To The Claim
Post-operative intraabdominal infection
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/17/200505-CA-4249
County Suit Filed inDate of Final Disposition
Okaloosa3/10/2009
Other Defendants Involved in this Claim
White Wilson Medical Center
Fort Walton Beach 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 DecisionOther
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$500,000
Loss Adjust Expense Paid to Defense Counsel$57,397
All Other Loss Adjustment Expense Paid$29,580
Injured Person's Total Non-Economic Loss$500,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$0$0
Wage Loss$49,181$1,837,472
Other Expenses$66,000$2,471,938
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Risk management has counseled insured
 
Updates
 
 
Date of Change:4/1/2009 4:14:51 PM
Reason for Change:Report udpated to reflect Court Document final disposition date of 03/10/09
 
Field ChangedFormer ValueNew Value
Date of Final Disposition08-OCT-0810-MAR-09

 

 

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Dr. Robert L Rogers Medical Malpractice Lawsuits - Court Case # 2009-CA-0010655

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201055943
Claim Number :28753
Date Submitted :1/5/2010
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualRobertLRogers
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 07$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME41071Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 FOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
2/8/20073/2/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hernia
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Hernia repair
Diagnostic Code : 
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to recognize and repair small bowel perforation following hernia repair
Principal Injury Giving Rise To The Claim
Small bowel perforation
Severity Of Injury
Temporary: Major - Burns, surgical material left, drug side effect, brain damage.Recovery delayed.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
2/4/20092009-CA-0010655
County Suit Filed inDate of Final Disposition
Okaloosa12/23/2009
Other Defendants Involved in this Claim
 
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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
12/23/2009
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$16,788
All Other Loss Adjustment Expense Paid$4,569
Injured Person's Total Non-Economic Loss$133,000
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$330,000$0
Wage Loss$37,727$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.

 

 

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Dr. J E Lujan Medical Malpractice Lawsuits - Court Case # 2010-CA-0033661S

Indemnity Paid: $500,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201263542
Claim Number :30415
Date Submitted :6/25/2012
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJELujan
Insurer TypeStreet Address of Practice
Licensed160 E. Redstone Ave.
CityStateZip CodeCounty
CrestviewFL32539Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1601010 08$250,000$750,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME54171Surgery - pediatric 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
NORTH OKALOOSA MEDICAL CENTER100122
Location of Institutional InjuryOther Location of Institutional Injury
Nursery 
Date of OccurrenceDate Reported to Insurer
1/12/20095/7/2009
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Hypoglycemia
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 hypoglycemia
Principal Injury Giving Rise To The Claim
Stroke and neurologic injury/blindness
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
6/10/20102010-CA-0033661S
County Suit Filed inDate of Final Disposition
Okaloosa4/5/2012
Other Defendants Involved in this Claim
Children's Clinic
North Okaloosa 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
3/5/2012
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$500,000
Loss Adjust Expense Paid to Defense Counsel$27,698
All Other Loss Adjustment Expense Paid$17,805
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$21,438$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
 
 
Date of Change:6/25/2012 12:36:45 PM
Reason for Change:Report updated to reflect Court Document final disposition date of 04/05/12
 
Field ChangedFormer ValueNew Value
Date of Final Disposition05-MAR-1205-APR-12

 

 

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Dr. John C Dali Medical Malpractice Lawsuits - Court Case # 2009-CA-5206

Indemnity Paid: $475,000.00

Medical Malpractice Closed Claims Report

 
Department File Number :M201161503
Claim Number :27981
Date Submitted :9/1/2011
 
Insurer Information
 
Insurer NameCoverage Type
MAG MUTUAL INSURANCE COMPANYPrimary
Insurer FEINProfessional License Number
58-1449198 
Insurer Contact Information
TypeEntity Name
EntityMAG Mutual Insurance Company
Street Address
8427 South Park Circle Suite 130
CityStateZip
OrlandoFL32819
PhoneExtFaxE-Mail Address
(407) 370 - 3813 (407) 370 - 2247ctschanz@magmutual.com
 
Insured Information
 
TypeFirst NameMILast Name
IndividualJohnCDali
Insurer TypeStreet Address of Practice
Licensed1005 Mar Walt Drive
CityStateZip CodeCounty
Fort Walton BeachFL32547Okaloosa
Policy NumberPer Claim Policy LimitsAggregate Policy Limits
PSL 1600398 07$500,000$1,500,000
Profession or BusinessOther Profession or Business
Medical Doctor 
License NumberSpecialty Code & ClassificationCertification Number
ME82923Surgery - General 

Medical Malpractice Closed Claims Report


 
 
Injured Person Information
 
First NameMILast NameDate of Birth
    
Street AddressGenderCounty where Injury Occurred
 MOkaloosa
CityStateZip Code
   
Location where injury occuredOther location where injury occured
Hospital Inpatient Facility 
Name of InstitutionCode
FORT WALTON BEACH MEDICAL CENTER100223
Location of Institutional InjuryOther Location of Institutional Injury
Patients' Room 
Date of OccurrenceDate Reported to Insurer
7/4/20088/18/2008
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Clot in the mesenteric artery
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 SMA embolus.
Principal Injury Giving Rise To The Claim
Ischemic bowel
Severity Of Injury
Permanent: Death.

Medical Malpractice Closed Claims Report

 

Legal Information
 
Date of SuitCircuit Court Case Number
10/4/20092009-CA-5206
County Suit Filed inDate of Final Disposition
Okaloosa8/1/2011
Other Defendants Involved in this Claim
4MD 2-In-Patient Physician Services of Ft. Walton Beach
Boutiette, MD, Lon A
Emergency Consultants, Inc
White Wilson Medical Center
Hospital Corporation of America
Fort Walton Beach 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 DecisionOther
No Court Proceedings. 
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/1/2011
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff?Yes
Indemnity Paid by Insurer on behalf of Insured$475,000
Loss Adjust Expense Paid to Defense Counsel$74,443
All Other Loss Adjustment Expense Paid$34,555
Injured Person's Total Non-Economic Loss$0
Deductible$0
Injured Person's Total Economic Loss
 Incurred to DateAnticipated
Medical Expense$150,000$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.

 

 

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