| Department File Number : | M201989227 |
| Claim Number : | 00007795 |
| Date Submitted : | 7/1/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Univ of FL JHMHC Self-Insurance Program | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-600205 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kristin | Belyew | |||
| Street Address | |||||
| PO BOX 112735 | |||||
| City | State | Zip | |||
| Gainesville | FL | 32611 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (352) 273 - 7232 | (352) 273 - 5424 | belyewK@ufl.edu | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Elham | Fakhre | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 1600 SW Archer Road | ||||
| City | State | Zip Code | County | ||
| Gainesville | FL | 32610 | Alachua | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| UFBOT10G | $300,000 | *NR | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME96683 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Suwannee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| SHANDS AT LIVE OAK (SUWANNEE) | 100146 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/29/2010 | 3/29/2010 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Pancreatitis | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Electrolyte imbalance | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Cardiac arrest and death | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/6/2011 | 2011209CA | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Suwannee | 6/29/2018 | ||||
| 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 not subject to Arbitration. | |||||
| Date of Payment | |||||
| 6/29/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $21,034 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $63,278 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Assessment of treatment with physician | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. ELHAM FAKHRE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ELHAM FAKHRE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).