Department File Number : | M201886946 |
Claim Number : | 38-01-2015-0053A |
Date Submitted : | 11/7/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MOUNT SINAI MEDICAL CENTER | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-0624424 | 4066 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | NANCY | CARR | |||
Street Address | |||||
11440 SW 88th STREET | |||||
City | State | Zip | |||
MIAMI | FL | 33176 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | C | Chaloupka | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 4302 Alton Road, Suite 830 | ||||
City | State | Zip Code | County | ||
Miami Beach | FL | 33140 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MSMCFGC-PR-A-15 MSMC16 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME109958 | Radiology - Diagnostic - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
MOUNT SINAI MEDICAL CENTER | 100034 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/19/2014 | 12/17/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Cervical pain with radiculopathy. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Fluoroscopic-guided therapeutic cervical epidural steroid/analgesic injection. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis of this patient. | |||||
Principal Injury Giving Rise To The Claim | |||||
Pain to the cervical region as well as loss of strength to right arm due to alleged spinal cord injury. The lawsuit was voluntarily dismissed against this practitioner. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/10/2016 | 16-010852 CA 01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 8/8/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $36,433 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,639 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Not applicable. |
Updates | |
No updates found. |
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Does Dr. JOHN C CHALOUPKA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN C CHALOUPKA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).