Department File Number : | M201576248 |
Claim Number : | TH-14-LLA-281891 |
Date Submitted : | 11/4/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
TEAM HEALTH, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
62-1562558 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
9821 Katy Freeway | |||||
City | State | Zip | |||
Houston | TX | 77024 | |||
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 | LUIS | O | DOMINGUEZ | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1000 JOE DIMAGGIO DRIVE | ||||
City | State | Zip Code | County | ||
HOLLYWOOD | FL | 33021 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
6797715 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7516 | Emergency Medicine - No Major 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 | ||||
Other Hospital/Institution | JOE DIMAGGIO CHILDREN'S HOSPITAL | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/30/2012 | 12/10/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
ENCEPHALITIS | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
TREATED IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
NO MISDIAGNOSIS | |||||
Principal Injury Giving Rise To The Claim | |||||
ENCEPHALITIS | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/26/2015 | ||||
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 | $4,749 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,864 | ||||||||||||||||||||
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. |
*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 : | M201676870 |
Claim Number : | 3829272480US |
Date Submitted : | 1/19/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LEXINGTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-1149494 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Crystil | Graves | |||
Street Address | |||||
17200 W 119th St | |||||
City | State | Zip | |||
Olathe | KS | 66061 | |||
Phone | Ext | Fax | E-Mail Address | ||
(913) 495 - 6598 | crystil.graves@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Luis | Dominguez | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1005 Joe DiMaggio Dr | ||||
City | State | Zip Code | County | ||
Hollywood | FL | 33021 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
006797715 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS7516 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Emergency Department | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/30/2012 | 12/10/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Encephalitis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Failure to diagnose | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose encephalitis, resulting in permanent brain damage | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to diagnose encephalitis, resulting in permanent brain damage | |||||
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 | 12/18/2015 | ||||
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 | |||||
Dropped before Action Filed | |||||
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 | $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 | |||||||||||||||||||||
N/A |
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. LUIS O DOMINGUEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LUIS O DOMINGUEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).