| Department File Number : | M201678067 |
| Claim Number : | 19139949 |
| Date Submitted : | 1/17/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HUDSON SPECIALTY INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 75-1637737 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yolanda | Burke | |||
| Street Address | |||||
| 851 Napa Valley Corporate Way, Suite N | |||||
| City | State | Zip | |||
| Napa | CA | 94558 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (707) 225 - 3331 | (707) 224 - 6858 | yburke@hudsoninsgroup.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Wilfredo | Corredera | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 105 Tomoka Blvd. South | ||||
| City | State | Zip Code | County | ||
| Lake Placid | FL | 33852 | Highlands | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCP4007401 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME63543 | 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 | Highlands | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/16/2012 | 7/24/2012 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| aortic abdominal aneurysm | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| failure to diagnose | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| failure to diagnose | |||||
| Principal Injury Giving Rise To The Claim | |||||
| aortic dissection | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/12/2013 | GC13-665 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Highlands | 3/25/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Taylor, Richard White, Gregory Adventist Health System EMCARE/JH Gatewood Emergency Services Chiropractic Wellness Center | |||||
| 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 | |||||
| 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 | $53,588 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $18,849 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| internal communication improvements | |||||||||||||||||||||
| Updates | |||||||||||||||||||
| Date of Change: | 11/4/2016 12:19:33 PM | ||||||||||||||||||
| Reason for Change: | Financial update | ||||||||||||||||||
| |||||||||||||||||||
| Date of Change: | 1/17/2017 4:02:53 PM | ||||||||||||||||||
| Reason for Change: | Wrong financials on the insured were reported | ||||||||||||||||||
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Does Dr. WILFREDO CORREDERA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILFREDO CORREDERA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).