Department File Number : | M201679677 |
Claim Number : | 310880 |
Date Submitted : | 9/11/2016 |
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 | Ivan | Menezes | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1530 Cornerstone Blvd., Suite 200 | ||||
City | State | Zip Code | County | ||
Daytona Beach | FL | 32117 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0962003 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME78170 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Volusia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
BERT FISH MEDICAL CENTER | 100014 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Emergency Room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/1/2011 | 10/2/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Hypotension, anemia, dehydration. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Treatment in ER included hydration and labs. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff subsequently diagnosed with MRSA related to prior orthopaedic surgery this insured was not involved and has been dismissed. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/6/2014 | 2013 32617 CICI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Volusia | 8/19/2016 | ||||
Other Defendants Involved in this Claim | |||||
Florida Hospital Memorial Medical Center Bryan, MD, James Gottlech, MD, Malcolm | |||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Other | Dropped as party Defendant | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $28,088 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,843 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
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. IVAN MENEZES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. IVAN MENEZES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).