Department File Number : | M201886275 |
Claim Number : | 59289501 |
Date Submitted : | 8/27/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PHYSICIANS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
13-4235490 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Renee | M | Silvia | ||
Street Address | |||||
901 S. Mopac Expwy, Blg. 5, Suite 500 | |||||
City | State | Zip | |||
Austin | TX | 78746 | |||
Phone | Ext | Fax | E-Mail Address | ||
(512) 425 - 5924 | renee-silvia@tmlt.org |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ARNOLD | VERA | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1667 N. Clyde Morris Blvd., Suite 2 | ||||
City | State | Zip Code | County | ||
Daytona Beach | FL | 32117 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
137154 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME76414 | Endocrinology - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Volusia | ||||
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 | ||||
11/18/2017 | 2/19/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
62 year old male presented with complaints of leg cramping. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient was seen in consultation and was prescribed Quinine Sulfate 200 mg. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Quetiapine 200 mg. was called into the pharmacy. The patient had an allergic reaction to the medication. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 8/2/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
8/9/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $3,059 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $412 | ||||||||||||||||||||
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 | |||||||||||||||||||||
No risk management issues identified. |
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. ARNOLD VERA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ARNOLD VERA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).