| Department File Number : | M201678831 |
| Claim Number : | C165751 |
| Date Submitted : | 6/27/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| ADMIRAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 22-2235730 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Angela | Rando | |||
| Street Address | |||||
| 1000 Howard Boulevard Suite 300 | |||||
| City | State | Zip | |||
| Mount Laurel | NJ | 08054 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (856) 857 - 3367 | arando@admiralins.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Alejandro | Perez | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 12651 W Sunrise Blvd Suite 104 | ||||
| City | State | Zip Code | County | ||
| Sunrise | FL | 33323 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| EO000028369-01 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Registered Nurse | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ARNP9201869 | Physicians or Surgeons | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Sarasota | ||||
| 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 | ||||
| Other | U S Stem Cell Clinic | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/6/2015 | 10/7/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Macular Degeneration | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| PLAINTIFF CLAIMS THE INSURED EXTRACTED ADIPOSE TISSUEFROM PLAINTIFF IN ORDER TO PROCESS AND ISOLATE STEMCELLS WHICH WERE THEN INJECTED INTO PLAINTIFF'S EYES.ALLEGEDLY THE INSURED SAID THIS PRODUCT/PROCEDURE WOULDSTOP THE PROGRESSION OF PLAINTIFF'S MACULARDEGENERATION. BASED ON THE INSURED'S ASSURANCE THEPLAINTIFF UNDERWENT THE INJECTIONS YET IT FAILED TOCOMPLY WITH THE EXPECTED RESULTS (THE INSURED'SWARRANTIES). | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| PLAINTIFF ALLEGES THE STEM CELL PRODUCT WASDEFECTIVE IN THE INSURED'S DESIGN AND MANUFACTURE AND ITWAS NEGLIGENTLY MARKETED AS A PRODUCT TO STOP THEPROGRESSION OF MACULAR DEGENERATION WHICH CAUSEDSIGNIFICANT INJURY TO THE PATIENT. PLAINTIFF SUFFERSFROM "COUNTING FINGERS VISION" DESCRIBED AS WALKINGAROUND YOUR HOUSE UNDER WATER. THE ONLY TWO WORSE STAGESOF VISION ARE "HANDS MOVEMENT ONLY" AND "TOTALBLINDNESS." | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/17/2015 | 2015-021463 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 5/24/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Bioheart Inc Greennbaum, Shareen | |||||
| 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 | |||||
| 5/26/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $475,085 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,425 | ||||||||||||||||||||
| 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 | |
| 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. ALEJANDRO PEREZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ALEJANDRO PEREZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).