Department File Number : | M201680735 |
Claim Number : | wc/101759-13 |
Date Submitted : | 12/27/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Watson Clinic LLP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-070493 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Diane | Szymanski | |||
Street Address | |||||
1600 Lakeland Hills Blvd | |||||
City | State | Zip | |||
Lakeland | FL | 33805 | |||
Phone | Ext | Fax | E-Mail Address | ||
(863) 680 - 7620 | (863) 616 - 2430 | aszymanski@watsonclinic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Elena | G | Botardo | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1600 Lakeland Hills Blvd | ||||
City | State | Zip Code | County | ||
Lakeland | FL | 33805 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PH1303749 | $2,000,000 | $18,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME66902 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | N/A no injury sustained | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/7/2011 | 8/12/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
colon cancer with liver metastasis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Not applicable, patient's condition was not related to an injury. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis in this case | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleges the failure to diagnose colon cancer in a 43-year old female with a long history of constipation. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/25/2013 | 2013CA005950000000 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 9/19/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Disposed of by Court | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $18,772 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,247 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstance of event was reviewed with individual parties involved. |
Updates | |
No updates found. |
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Does Dr. ELENA G BOTARDO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ELENA G BOTARDO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).