Department File Number : | M201990708 |
Claim Number : | 69596 |
Date Submitted : | 11/22/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tonya | Ponder | |||
Street Address | |||||
3535 Piedmont Rd., NE, Bldg. 14 - Ste. 1000 | |||||
City | State | Zip | |||
Atlanta | GA | 30305 | |||
Phone | Ext | Fax | E-Mail Address | ||
(404) 842 - 5556 | tponder@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Enos | Perez | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8250 Bryan Dairy Rd., Suite 305 | ||||
City | State | Zip Code | County | ||
Largo | FL | 33777 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1600091 00 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME79914 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
WEST COAST ENDOSCOPY CENTER | 14960448 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Not in inpatient facility | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/25/2016 | 7/23/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Presented for routine check-up and reported pain in epigastric region that sometimes worsened to the right upper quadrant | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Physical examination | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose cholangiocarcinoma | |||||
Principal Injury Giving Rise To The Claim | |||||
Metastasis | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/22/2019 | 19-002649-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 10/22/2019 | ||||
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 | |||||
10/22/2019 |
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 | $25,873 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,350 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk Management has counseled insured |
Updates | |
No updates found. |
Does Dr. ENOS PEREZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ENOS PEREZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).