Department File Number : | M201575825 |
Claim Number : | 153977 |
Date Submitted : | 8/26/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Teresa | Ross | |||
Street Address | |||||
One Park Plaza P.O. Box 555 | |||||
City | State | Zip | |||
Nashville | TN | 37202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 5804 | Teresa.Ross@HCAHealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | Fernandez | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 13965 US Highway 1 | ||||
City | State | Zip Code | County | ||
Sebastian | FL | 32958 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10113 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME65400 | Emergency Medicine - No Major Surgery | 01 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
COLUMBIA HOSPITAL | 100234 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Emergency Room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/15/2013 | 2/21/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Altered mental status, cardiac arrest. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient brought to ER in combative state. Given Ativan & Geodon & later found to be experiencing shallow respirations & coded. Resuscitative efforts provided but patient experienced catastrophic insult resulting in anoxic encephalopathy. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Anoxic encephalopathy. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/9/2015 | ||||
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 | |||||
8/31/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $1,000,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $29,577 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $24,162 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $330,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Review of policies and procedures. |
Updates | |||||||||||||
Date of Change: | 10/2/2015 2:49:53 PM | ||||||||||||
Reason for Change: | Additional LAE payments made. | ||||||||||||
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Date of Change: | 8/26/2016 10:07:55 AM | ||||||||||||
Reason for Change: | Additional LAE payments made. | ||||||||||||
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*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 : | M201783241 |
Claim Number : | SGI-16-349973 |
Date Submitted : | 10/3/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CITADEL INSURANCE, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-8474742 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JOHN | FERNANDEZ | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 13965 US HWY 1 | ||||
City | State | Zip Code | County | ||
SEBASTIAN | FL | 32958 | Indian River | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CMI AE 1601 046 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME65400 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
SEBASTIAN RIVER MEDICAL CENTER | 100217 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/23/2016 | 9/20/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
STROKE SYMPTOMS | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEEN IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
ALLEGED FAILURE TO DIAGNOSE AND TREAT | |||||
Principal Injury Giving Rise To The Claim | |||||
NEUROLOGICAL DEFICITS | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/3/2017 | ||||
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 | |||||
9/12/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $670,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $20,022 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,648 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN |
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 : | M201987676 |
Claim Number : | SGI-17-368820 |
Date Submitted : | 1/23/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
The Schumacher Group | Primary | ||||
Insurer FEIN | Professional License Number | ||||
72-1383025 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JOHN | R | FERNANDEZ | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 200 CORPORATE BLVD. | ||||
City | State | Zip Code | County | ||
LAFAYETTE | LA | 70508 | Out of state | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CMI AE 1701 046 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME65400 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Indian River | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
SEBASTIAN RIVER MEDICAL CENTER | 100217 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/2/2017 | 6/6/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
CHEST PAIN | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEE IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
ALLEGED FAILURE TO TIMELY DIAGNOSE AND TREAT | |||||
Principal Injury Giving Rise To The Claim | |||||
ADDITIONAL CARE | |||||
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 | ||||
10/18/2017 | NOI1 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Indian River | 1/23/2019 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within 90 days of suit being filed. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
12/13/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $99,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN |
Updates | |
No updates found. |
Does Dr. JOHN FERNANDEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN FERNANDEZ, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).