Department File Number : | M201885353 |
Claim Number : | 217925 |
Date Submitted : | 7/10/2018 |
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 | SIU-MEI | M | CHAN | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4960 SW 72nd Avenue, Suite 400 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33155 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
ES1855 | $1,000,000 | $5,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME100289 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Monroe | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Prison | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Correctional Facility | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/28/2015 | 1/27/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient alleged failure to treat head and eye wounds after falling out of bed which lead to a concussion traumatic brain injury and loss of vision. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Failure to treat. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
Concussion, TBI and loss of vision. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/27/2017 | 16-10080-CIV-MOORE | ||||
County Suit Filed in | Date of Final Disposition | ||||
Monroe | 3/26/2018 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
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 | $13,210 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,189 | ||||||||||||||||||||
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: | 7/10/2018 1:47:13 PM | ||||||
Reason for Change: | updated alae | ||||||
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Does Dr. SIU-MEI M CHAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SIU-MEI M CHAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).