| Department File Number : | M201781752 |
| Claim Number : | TH-15-LLA-293515 |
| Date Submitted : | 4/7/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| TEAM HEALTH, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 62-1562558 | |||||
| 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 | DORIAN | K | MADRID | ||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 301 N. ALEXANDER ST. | ||||
| City | State | Zip Code | County | ||
| PLANT CITY | FL | 33563 | Lake | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 6797715 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Other | PHYSICIAN ASSISTANT | ||||
| License Number | Specialty Code & Classification | Certification Number | |||
| PA9106025 | |||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lake | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| SOUTH FLORIDA BAPTIST HOSPITAL | 100132 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/13/2014 | 6/15/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| TONSILITIS | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| SEEN IN ER | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| ALLEGED FAILURE TO DIAGNOSE | |||||
| Principal Injury Giving Rise To The Claim | |||||
| SEPSIS AND DEATH. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/11/2016 | 2016-CA-000199 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 4/7/2017 | ||||
| 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 | |||||
| 3/9/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $22,101 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $8,242 | ||||||||||||||||||||
| 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. |
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Does Dr. DORIAN K MADRID, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DORIAN K MADRID, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).