Department File Number : | M201886033 |
Claim Number : | 162400 |
Date Submitted : | 7/30/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NORCAL MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
94-2301054 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | Lance | |||
Street Address | |||||
4651 Salisbury Rd Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 309 - 8129 | jlance@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Renato | Roza | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7925 N Wickham Rd Suite A | ||||
City | State | Zip Code | County | ||
Melbourne | FL | 32940 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
723591N | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Physician Assistant | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9101365 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Brevard | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/4/2016 | 3/30/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Shortness of breath x 3 days | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Physical examination | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Pt diagnosed with shortness of breath and anxiety | |||||
Principal Injury Giving Rise To The Claim | |||||
Bilateral pulmonary emboli | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/18/2017 | 052016cp014211 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Brevard | 5/10/2018 | ||||
Other Defendants Involved in this Claim | |||||
Medfast Urgent Care Centers, LLC Williams, David T Blythe, Stephen LEYTE-VIDAL, SANTIAGO | |||||
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 | |||||
5/10/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $1,000,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $25,377 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Discussed case with insured. Will contact risk management if necessary |
Updates | |
No updates found. |
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Does Dr. RENATO ROZA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RENATO ROZA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).