Department File Number : | M201884040 |
Claim Number : | 70692-B |
Date Submitted : | 1/9/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-2813188 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | James | P | Lacey | ||
Street Address | |||||
76 S. Laura Street, Suite 900 | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (888) 974 - 6458 | claims@medmaldirect.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kimberly | A | Gore | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2919 W. Swain Avenue | ||||
City | State | Zip Code | County | ||
Tampa | FL | 33609 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL708073 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Physician Assistant | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PA2625 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/23/2014 | 3/31/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Allergic reaction - unspecified. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Medical management and Epi-pen. | |||||
Diagnostic Code : | 09 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None. | |||||
Principal Injury Giving Rise To The Claim | |||||
Allergic reaction resulting in death. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
6/28/2016 | 17-CA-000976 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hillsborough | 12/29/2017 | ||||
Other Defendants Involved in this Claim | |||||
GMS Florida West Coast, Inc. Torres, Christine H | |||||
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 | |||||
1/3/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $3,076 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None. |
Updates | |
No updates found. |
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Does Dr. KIMBERLY A GORE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KIMBERLY A GORE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).