| Department File Number : | M201781139 |
| Claim Number : | 2014FL490 |
| Date Submitted : | 2/8/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PHYSICIANS CASUALTY RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 27-3867083 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jody | Schwahn | |||
| Street Address | |||||
| 401 Corbett Street Suite 200 | |||||
| City | State | Zip | |||
| Clearwater | FL | 33756 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 581 - 6400 | jschwahn@physicianscasualty.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | MARAY | ROCHER GOMEZ | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 87 E. 49th Street | ||||
| City | State | Zip Code | County | ||
| Hialeah | FL | 33013 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PC-2014-409 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME100487 | 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 | ||||
| Nursing Home | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/25/2013 | 9/16/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Admitted to short-term rehabilitation facility. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged failure to treat asymptomatic urinary tract infection. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged failure to treat asymptomatic urinary tract infection. | |||||
| 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 | ||||
| 3/11/2016 | 16-6212 CA 05 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 2/2/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Heartland of Kendall, FL LLC Leon Medical Centers, Inc. | |||||
| 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 | |||||
| 2/7/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $99,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $33,501 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $16,327 | ||||||||||||||||||||
| 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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MARAY ROCHER GOMEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARAY ROCHER GOMEZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).