Department File Number : | M201574607 |
Claim Number : | SAM-IG-005296 |
Date Submitted : | 5/13/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SAMARITAN RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3433505 | |||||
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 | JUAN | C | ACEVEDO-CRESPO | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 747 PONCE DE LEON BLVD | ||||
City | State | Zip Code | County | ||
CORAL GABLES | FL | 33134 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
SPL1047 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME63849 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/9/2010 | 1/10/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
PULMONARY NODULES AND COPD | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
THERE WAS NO OPERATION, DIAGNOSTIC OR TREATMENT PROCEDURE THAT CAUSED INJURY | |||||
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 | |||||
DEATH. THE CLAIMANT ATTORNEY ALLEGED A FAILURE TO FOLLOW UP ON BLOOD TESTS AND PATHOLOGY RESULTS FROM A HOSPITALIZATION WHEREIN THE PATIENT WAS TREATED BY OTHER HEALTHCARE PORVIDERS. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 7/20/2012 | ||||
Other Defendants Involved in this Claim | |||||
SANCHEZ, JOSE U CAC-FLORIDA MEDICAL CENTERS, LLC THARMARAJAH, SASHIKUMAR GONZALEZ, RENE D | |||||
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 | |||||
7/20/2012 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $240,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $8,739 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $15,682 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $240,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
PHYSICIAN DISCUSSED CASE WITH DEFENSE COUNSEL |
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. JUAN C ACEVEDO-CRESPO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JUAN C ACEVEDO-CRESPO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).