| Department File Number : | M201783463 |
| Claim Number : | SHI-16-354376 |
| Date Submitted : | 10/23/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | DEREK | G | BAZEMORE | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1613 N HARRISON PARKWAY, STE 200 | ||||
| City | State | Zip Code | County | ||
| SUNRISE | FL | 33323 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HAZ4032218126-1 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME107380 | Emergency Medicine - No Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | KENDALL REGIONAL MEDICAL CENTER | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/7/2015 | 12/7/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| SHOULDER PAIN | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| SEEN IN ER | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FAILURE TO DIAGNOSE | |||||
| Principal Injury Giving Rise To The Claim | |||||
| BACTERIAL ENDOCARDITIS | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 9/21/2017 | ||||
| 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 | |||||
| 8/31/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $850,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $29,282 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $3,648 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| 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.
| Department File Number : | M201677418 |
| Claim Number : | SHI-14-280543 |
| Date Submitted : | 3/2/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | DEREK | BAZEMORE | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1400 PELHAM PARKWAY S. | ||||
| City | State | Zip Code | County | ||
| BRONX | NY | 10461 | Out of state | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HAZ1064401339-11 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME107380 | Emergency Medicine - No Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | KENDALL REGIONAL MEDICAL CENTER | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/13/2013 | 11/8/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| RIGHT EYE PAIN, DISCOMFORT AND VISUAL DIFFICULTY | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| EXAMINED IN ER. CT AND MRI OF HEAD AND LABS WITHIN NORMAL LIMITS. DISCHARGED | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| FINDINGS WITHIN NORMAL LIMITS | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DETACHED RETINA | |||||
| Severity Of Injury | |||||
| Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/29/2015 | 2015-012412-CA-01 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 3/2/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 subject to arbitration, but settlement reached in lieu of award. | |||||
| Date of Payment | |||||
| 3/1/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $23,738 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $3,763 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
Does Dr. DEREK G BAZEMORE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DEREK G BAZEMORE, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).