Department File Number : | M202092005 |
Claim Number : | JY14J0021780 |
Date Submitted : | 3/31/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ACE AMERICAN INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-2371728 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | BETH | A | FOLEY | ||
Street Address | |||||
525 W Monroe, Ste 800, 912 | |||||
City | State | Zip | |||
CHICAGO | IL | 60661 | |||
Phone | Ext | Fax | E-Mail Address | ||
(312) 502 - 7131 | BETH.FOLEY@CHUBB.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | DIEGO | ADARVE | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 12250 TAMIAMI TRAIL, STE 101 | ||||
City | State | Zip Code | County | ||
TAMPA | FL | 34113 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
G2678082 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO3253 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Hillsborough | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | facility | ||||
Name of Institution | Code | ||||
GULF COAST SURGERY CENTER | 34 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | GULF COAST FOOT AND ANKLE CENTER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/16/2012 | 1/13/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
right toe amputation | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
removal of tip of right toe | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
no misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
right toe tip amputated | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/2/2015 | 99999 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 10/10/2019 | ||||
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 | ||||
Other | SETTLED AT MEDIATION | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/10/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $120,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $8,534,585 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 steps taken |
Updates | |
No updates found. |
Does Dr. DIEGO ADARVE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DIEGO ADARVE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).