| Department File Number : | M201576662 |
| Claim Number : | 59204801 |
| Date Submitted : | 12/23/2015 |
| 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 | Antrine | Long | |||
| Street Address | |||||
| 361 Hillsboro Blvd. | |||||
| City | State | Zip | |||
| Deerfield Beach | FL | 33441 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 788 - 5184 | (954) 944 - 1382 | along@picinsurance.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Benedicto | San Pedro | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 3731 Lake Worth Road, Suite 1 | ||||
| City | State | Zip Code | County | ||
| Lake Worth | FL | 33461 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 131638 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME29312 | Physicians - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Nursing Home | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/30/2013 | 11/25/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| 14 yr old patient, with history of seizure mental development was resident at a group home for the mentally-handicapped. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Insured served as Primary Care Physician for residents that did not have an assigned PCP. He had a initial consult with the patient upon admission, and made changes to the patient's medication routine. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient died on 6/30/2013. Cause of Death could not be determined. It was alleged that the change in medication ordered by the insured was cause. It was believed the cause of death was due to respiratory failure and secondary seizure disorder. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/25/2014 | 2014-CA-011437 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 11/24/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| National Mentor Healthcare Palm Beach Physicians | |||||
| 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 | |||||
| 12/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $49,575 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $15,000 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| none applied | |||||||||||||||||||||
| 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. BENEDICTO SAN PEDRO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BENEDICTO SAN PEDRO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).