Department File Number : | M201987578 |
Claim Number : | 00036182 |
Date Submitted : | 1/11/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Univ of FL JHMHC Self-Insurance Program | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-600205 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kristin | Belyew | |||
Street Address | |||||
PO BOX 112735 | |||||
City | State | Zip | |||
Gainesville | FL | 32611 | |||
Phone | Ext | Fax | E-Mail Address | ||
(352) 273 - 7232 | (352) 273 - 5424 | belyewK@ufl.edu |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mary | Lim | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 580 W. Eighth Street | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32209 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
UFBOT14J | $300,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME43795 | Pediatrics - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
UNIVERSITY MEDICAL CENTER (DUVAL) | 100001 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/18/2014 | 4/21/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Premature infant with pneumothorax | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Pneumothorax Aspiration | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Coronary Artery Perforation | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/18/2016 | 16CA1650 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 8/25/2017 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
8/25/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $290,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $700 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $23,537 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Assessment of treatment with physician |
Updates | |
No updates found. |
Does Dr. MARY LIM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARY LIM, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).