Department File Number : | M201783744 |
Claim Number : | SAM-IG-007554 |
Date Submitted : | 11/29/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SAMARITAN RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3433505 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | NANCY | CARR | |||
Street Address | |||||
11440 SW 88th STREET | |||||
City | State | Zip | |||
MIAMI | FL | 33176 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Samia | Zaki | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 9915 N.W. 41st Street | ||||
City | State | Zip Code | County | ||
Doral | FL | 33178 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
SPL 1088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME78986 | 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 | |||
M | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
SOUTH MIAMI HOSPITAL | 100154 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | South Miami Hosp Doral Urgent Care Ctr | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/27/2015 | 6/21/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Right thumb laceration. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
None. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis made. | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient was treated and sutured for right thumb laceration and antibiotics were prescribed and the extremity immobilized. He was followed for wound checks, new antibiotics were prescribed and the patient was referred to hand specialist. The patient subsequently underwent exploratory surgery of the thumb which revealed pseudomonas infection, right thumb volar laceration and right thumb flexor pollicis brevis tendon and muscle laceration. The Notice of Intent was voluntarily withdrawn against this practitioner. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/11/2017 | ||||
Other Defendants Involved in this Claim | |||||
South Miami Hospital Doral Urgent Care Center | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
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 | $3,732 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11,054 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Not applicable. |
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. SAMIA ZAKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SAMIA ZAKI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).