Department File Number : | M201575660 |
Claim Number : | 316430 |
Date Submitted : | 8/28/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Martha | Pereira | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 422 Palermo Avenue | ||||
City | State | Zip Code | County | ||
Miami | FL | 33124 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0958807 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Licensed Practical Nurse | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9252828 | Surgery - Obstetrics - Gynecology |
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 | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
BAPTIST HOSPITAL OF MIAMI | 100008 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/20/2012 | 3/20/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient sought treatment for abdominal pain. The final diagnosis was abscess and sepsis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient underwent a laparoscopy of the pelvis and abdomen. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to apprecaiate the patient's condition. | |||||
Principal Injury Giving Rise To The Claim | |||||
Death. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/14/2014 | 14-21327 CA 09 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 8/13/2015 | ||||
Other Defendants Involved in this Claim | |||||
South Florida Gynecologic Oncology, LLC Mendez, Luis Vitalmd Group | |||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Other | Case Dismissed | ||||
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 | $46,962 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $43,382 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
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Does Dr. MARTHA PEREIRA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARTHA PEREIRA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).