Department File Number : | M201576305 |
Claim Number : | 1018519-01 |
Date Submitted : | 8/11/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Susan | K | Spielman | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Carlos | A | Archilla | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 901 45th Street | ||||
City | State | Zip Code | County | ||
West Palm Beach | FL | 33407 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
654010 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME78138 | Anesthesiology |
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 | ||||
Other Hospital/Institution | St. Mary's Medical Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/3/2012 | 4/5/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Craniosynostosis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Surgery to release suture line on skull | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to obtain additional lab tests and blood gases post op | |||||
Principal Injury Giving Rise To The Claim | |||||
Severe neurological impairment | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/17/2014 | 50 2014 CA 010078 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Palm Beach | 11/6/2015 | ||||
Other Defendants Involved in this Claim | |||||
St Mary's Medical Center Patel DO, Neil N Palm Beach Neuroscience Institute Anesthesia and Critical Care Specialists of Palm Beach PA Fante CRNA, Susan M Egea MD, Marcelo Kidz Medical Services Inc Boo MD, Heather E Heather E Boo MD PA Butler MD, Howard G Howard G Butler MD PA Imaging Consultants of South Florida Iyer MD, Krishna V De La Cruz RN, Almaida S Reed RN, Jada R Johnson Panczak RN, Tina L Fitzgerald ARNP, Sarah N Rodriguez RN, Aimee | |||||
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 | |||||
11/4/2015 |
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 | $28,039 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,924 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $82,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 1/28/2016 9:08:17 AM | |||||||||
Reason for Change: | ALE UPDATE 1/28/2016 | |||||||||
| ||||||||||
Date of Change: | 8/11/2016 10:18:55 AM | |||||||||
Reason for Change: | ALE UPDATED 8/11/2016 | |||||||||
|
This page is not displaying certain sensitive information.
Does Dr. CARLOS A ARCHILLA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CARLOS A ARCHILLA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).