| Department File Number : | M201574879 |
| Claim Number : | 323474 |
| Date Submitted : | 6/9/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-3014772 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kelly | Andrews | |||
| Street Address | |||||
| 12724 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ABRAHAM | RIVERA | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 38135 Market Square | ||||
| City | State | Zip Code | County | ||
| Zephyrhills | FL | 33542 | Pasco | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0966737 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME93446 | Anesthesiology - Pain Management | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/5/2013 | 10/14/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Failed back syndrome and post laminectomy syndrome. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Placement and programming of external epidural infusion - PCA pump. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 5/20/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Florida Medical Clinic, PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| 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? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $15,312 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| 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.
| Department File Number : | M201780846 |
| Claim Number : | FP3888202 |
| Date Submitted : | 1/13/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-6614702 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kelly | Andrews | |||
| Street Address | |||||
| 12724 Gran Bay Parkway, W., Suite 400 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Abraham | Rivera | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4703 N. Amenia Avenue | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33603 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FP-CL103501 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Other | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME93446 | |||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Armenia Ambulatory Surgery Center | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/11/2009 | 12/15/2011 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Increasingly severe chronic pain and disability from lumbosacral disc degeneration and fracture associated with prior skydiving accident. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Percutaneous placement by colleague physician of electrodes in trial of spinal cord stimulator. Insured disputes colleague physician's claim that insured was her proctor for this procedure. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged worsening of pain and disability related to abrupt patient movement during the placement of spinal cord stimulator leads. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/7/2012 | 11-CA-016723 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 12/27/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Stone, MD, Carissa H Riveria, MD, Abraham | |||||
| 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 | |||||
| 12/27/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $183,327 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $161,085 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| 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. ABRAHAM RIVERA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ABRAHAM RIVERA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).