Department File Number : | M202092701 |
Claim Number : | 166873-2 |
Date Submitted : | 6/9/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE INDEMNITY, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
61-0904881 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christina | J | Stoker | ||
Street Address | |||||
2515 PARK PLAZA, BLDG 2-3E | |||||
City | State | Zip | |||
Nashville | TN | 37203 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 344 - 1779 | (866) 715 - 7235 | christina.stoker@hcahealthcare.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MAYRA | I | BAEZ | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 700 W OAK ST | ||||
City | State | Zip Code | County | ||
KISSIMMEE | FL | 34741 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HCI-10118 | $5,000,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Other | REGISTERED NURSE | ||||
License Number | Specialty Code & Classification | Certification Number | |||
RN9195028 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
OSCEOLA REGIONAL HOSPITAL | 100110 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Recovery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/26/2019 | 1/29/2019 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
SEVERE ABDOMINAL PAIN; HEMORRHAGIC OVARIAN CYST. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
OVARIAN CYSTECTOMY, LYSIS OF ADHESIONS, EVACUATION OF HEMOPERITONEUM W/O COMPLICATION. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
CARDIAC ARREST, ANOXIC BRAIN INJURY; DEATH. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/14/2019 | 2019CA001475MP | ||||
County Suit Filed in | Date of Final Disposition | ||||
Osceola | 5/26/2020 | ||||
Other Defendants Involved in this Claim | |||||
MILLER, M.D., DALE PAK, CRNA, MILA ANESTHESIA PHYSICIAN SOLUTIONS OF NORTH FLORIDA, LLC | |||||
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 | |||||
5/18/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $750,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $11,323 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,813 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $105,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
REFERRED TO RISK MANAGEMENT. |
Updates | |
No updates found. |
Does Dr. MAYRA I BAEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MAYRA I BAEZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).