Department File Number : | M202091999 |
Claim Number : | JY16J0135333 |
Date Submitted : | 3/31/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ACE AMERICAN INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-2371728 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kimberly | Acevedo | |||
Street Address | |||||
10 Exchange Place | |||||
City | State | Zip | |||
Jersey City | NJ | 07302 | |||
Phone | Ext | Fax | E-Mail Address | ||
(201) 356 - 5245 | kimberly.acevedo@chubb.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Monica | Andres | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7190 SW 87 Avenue, Suite 205 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33173 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CRL121951 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO3223 |
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 Outpatient Facility | |||||
Name of Institution | Code | ||||
MEDICAL ARTS SURGERY CENTER AT SOUTH MIAMI | 14960546 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/4/2014 | 3/14/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
ankle fracture | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
open reduction external fixation surgery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
osteomyelitis | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/6/2016 | 43624103 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 10/12/2018 | ||||
Other Defendants Involved in this Claim | |||||
Carbonell, Jamie Garnet & Carbonell, DPM, 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 | ||||
Other | settlement | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/11/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $43,333 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $387 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $200,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Settled to avoid costs and expense of litigation |
Updates | |
No updates found. |
Does Dr. MONICA ANDRES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MONICA ANDRES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).