Department File Number :

M200430764

Claim Number :

6174-01

Date Submitted :

5/5/2004

 

Insurer Information

 

Insurer Name

Coverage Type

PODIATRY INSURANCE COMPANY OF AMERICA, A MUTUAL COMPANY

Primary

Insurer FEIN

Professional License Number

58-1403235

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

DEBBIE

E

PHILLIPS

Street Address

110 Westwood Place, Suite 100

City

State

Zip

Brentwood

TN

37027

Phone

Ext

Fax

E-Mail Address

(615) 371 - 8776

2063

(888) 329 - 7422

dphillips@picagroup.com

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

KENNETH

 

SABACINSKI, DPM

Insurer Type

Street Address of Practice

Licensed

1150 NO. 35TH AVE., #255

City

State

Zip Code

County

HOLLYWOOD

FL

33021

Broward

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

10354

$250,000

$750,000

Profession or Business

Other Profession or Business

Podiatric Physician

 

License Number

Specialty Code & Classification

Certification Number

2030

 

N/A

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

*NR

City

State

Zip Code

 

 

 

Location where injury occured

Other location where injury occured

Other Outpatient Facility

 

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

6/13/2000

4/1/2002

 

Diagnostic Information

 

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition

Painful buions and trailor's bunions, bilaterally

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Modified McBride bunionectomy and non-fixated 5th met osteotomy, bilaterally

Diagnostic Code :

 

Misdiagnosis Made, If Any, Of Patient's Actual Condition

None

Principal Injury Giving Rise To The Claim

Continued pain

Severity Of Injury

Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

8/27/2002

02016560CA25

County Suit Filed in

Date of Final Disposition

Broward

3/16/2004

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 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

$250,000

Loss Adjust Expense Paid to Defense Counsel

$36,382

All Other Loss Adjustment Expense Paid

$7,004

Injured Person's Total Non-Economic Loss

$0

Deductible

$0

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

None

 

Updates

 

No updates found.