Department File Number : | M201573288 |
Claim Number : | 107-018450 |
Date Submitted : | 1/23/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LEXINGTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-1149494 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Cyndie | Fernandez | |||
Street Address | |||||
3650 Brookside Parkway | |||||
City | State | Zip | |||
Alpharetta | GA | 30023 | |||
Phone | Ext | Fax | E-Mail Address | ||
(678) 240 - 1613 | cyndie.fernandez@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Raul | E | Daza | ||
Insurer Type | Street Address of Practice | ||||
Licensed | c/o Wicker, Smith,O'Hara,McCoy & Ford atty - 2800 Ponce de Leon Blvd. Ste. 800 | ||||
City | State | Zip Code | County | ||
Coral Gables | FL | 33134 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
67963-45-02-41 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME96199 | Internal Medicine - 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 | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/1/2013 | 7/17/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pre suit affidavit of Dr. David Mayer alleging malpractice. Drainage in surgical site. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Pre suit affidavit of Dr. David Mayer alleging malpractice. Drainage in surgical site. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Pre suit affidavit of Dr. David Mayer alleging malpractice. Drainage in surgical site. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/17/2013 | CACE13004417 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 1/21/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Better access patients |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. RAUL E DAZA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RAUL E DAZA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).