Department File Number : | M201884935 |
Claim Number : | 1022044-01 |
Date Submitted : | 10/18/2018 |
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 | Victor | L | Herrera | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 9765 San Jose Blvd Ste 107 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32257 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
785179 | $100,000 | $300,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO3517 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MERCY HOSPITAL, INC. | 100061 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/7/2013 | 11/3/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Flat foot | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Surgery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Surgical repair failed | |||||
Principal Injury Giving Rise To The Claim | |||||
Second surgery and deformity | |||||
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 | ||||
1/27/2015 | 2016-001649 CA 01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 3/21/2018 | ||||
Other Defendants Involved in this Claim | |||||
Victor L Herrera DPM PA Herrera DPM, Martha G Martha G Herrera DPM PA Flera LLC Barry University School of Podiatric Medicine Club Corp | |||||
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 | |||||
3/21/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $22,831 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,743 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $70,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
Updates | ||||||||||
Date of Change: | 8/22/2018 11:04:38 AM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
| ||||||||||
Date of Change: | 10/18/2018 11:44:15 AM | |||||||||
Reason for Change: | corrected policy limits 10/18/2018 | |||||||||
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Does Dr. VICTOR L HERRERA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. VICTOR L HERRERA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).