Department File Number : | M201783852 |
Claim Number : | 1023965 |
Date Submitted : | 8/22/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Veronica | Versari | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 440 West 49 Street | ||||
City | State | Zip Code | County | ||
Hialeah | FL | 33012 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
749614 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME108816 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Nursing Home | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Nursing home lobby | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/16/2012 | 2/5/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Wound care | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Medication | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Prescribed sulfa based RX; patient allergic | |||||
Principal Injury Giving Rise To The Claim | |||||
Renal failure and death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/18/2016 | 14-005073 CACE (05) | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 11/27/2017 | ||||
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 | ||||
Judgment for the defendant. | |||||
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 | $40,387 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $13,040 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/a |
Updates | ||||||||||
Date of Change: | 2/1/2018 2:12:54 PM | |||||||||
Reason for Change: | ALE UPDATE 2/1/2018 | |||||||||
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Date of Change: | 8/22/2018 1:46:30 PM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. VERONICA VERSARI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. VERONICA VERSARI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).