Department File Number : | M201884494 |
Claim Number : | 209739 |
Date Submitted : | 5/24/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PROASSURANCE CASUALTY COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
38-2317569 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Denise | Stokes | |||
Street Address | |||||
100 Brookwood Place | |||||
City | State | Zip | |||
Birmingham | AL | 35209 | |||
Phone | Ext | Fax | E-Mail Address | ||
(205) 802 - 4790 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mayuri | P | Gupta | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 5340 N Federal Highway, Suite 101 | ||||
City | State | Zip Code | County | ||
Lighthouse Point | FL | 33064 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MP97370 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME109736 | Gastroenterology - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
BROWARD SPECIALTY SURGICAL CENTER | 14960734 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/6/2014 | 1/20/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
patient presented requesting a screening colonoscopy | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
colonoscopy and polypectomy | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient suffered a colon perforation, a recognized complication, which was timely recognized and treated | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/4/2016 | 16-007682 (13) | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 2/19/2018 | ||||
Other Defendants Involved in this Claim | |||||
Premium Practice Solutions, 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 | |||||
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 | $16,405 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $18,342 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insured discussed case with defense counsel, insurance personnel, and medical experts. |
Updates | ||||||||||
Date of Change: | 3/6/2018 3:56:14 PM | |||||||||
Reason for Change: | Updated ALAE information | |||||||||
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Date of Change: | 5/24/2018 8:41:16 AM | |||||||||
Reason for Change: | updated alae | |||||||||
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Does Dr. MAYURI P GUPTA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MAYURI P GUPTA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).