Department File Number : | M201781786 |
Claim Number : | F16-0049-15 |
Date Submitted : | 4/11/2017 |
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 | jason | haynie | |||
Street Address | |||||
4651 Salisbury Rd., Ste. 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | jhaynie@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Catalina | Alain | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 3956 W Town Center Blvd, Unit 119 | ||||
City | State | Zip Code | County | ||
Orlando | FL | 32837 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MG001233 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9170493 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Primary HealthCare Associates | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Primary HealthCare Associates | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/23/2015 | 2/17/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient with history of asthma presented with a cough for 5 days. The nurse administered a Kenelog injection in the buttocks. Patient developed an indentation at the injection site requiring repair by a plastic surgeon. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Kenelog injection in the buttocks. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failed to adequately and appropriately administer Kenelog injection. | |||||
Principal Injury Giving Rise To The Claim | |||||
Indentation of the buttocks. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/6/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
11/30/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $5,084 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Discussed with 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 : | M201782424 |
Claim Number : | F16-0049-15 |
Date Submitted : | 6/23/2017 |
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 | Catalina | Alain | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 431. Semoran Boulevard | ||||
City | State | Zip Code | County | ||
Orlando | FL | 32807 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MG001233 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9170493 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Orange | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Outpatient Facility | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Outpatient Facility | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/23/2015 | 2/17/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Persistent cough | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Steroid injection | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to supervise | |||||
Principal Injury Giving Rise To The Claim | |||||
Dermal infection resulting in skin indentation | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 11/30/2016 | ||||
Other Defendants Involved in this Claim | |||||
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 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 | $15,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $7,726 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Matter discussed with insured and appropriate measures have been applied |
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. CATALINA ALAIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CATALINA ALAIN, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).