Department File Number : | M201575265 |
Claim Number : | 22289 |
Date Submitted : | 9/23/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ALBERTO | M | DE LA RIVAHERRERA | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1112 Goodlette Rd., Ste. 204 | ||||
City | State | Zip Code | County | ||
Naples | FL | 34102 | Collier | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1600941 03 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME65683 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Collier | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
NORTH COLLIER HOSPITAL | 120006 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/8/2004 | 6/29/2005 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Myocardial infarction | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to diagnose myocardial infarction | |||||
Principal Injury Giving Rise To The Claim | |||||
Permanent heart damage | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
6/13/2006 | 06-0951-CA | ||||
County Suit Filed in | Date of Final Disposition | ||||
Collier | 9/8/2015 | ||||
Other Defendants Involved in this Claim | |||||
North Collier Hospital Emergency Physicians of Naples | |||||
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 | |||||
7/7/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $129,707 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $67,306 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |||||||
Date of Change: | 9/23/2015 12:42:20 PM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 09/08/15 | ||||||
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Does Dr. ALBERTO M DE LA RIVAHERRERA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ALBERTO M DE LA RIVAHERRERA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).