Department File Number : | M201676881 |
Claim Number : | 29040-1 |
Date Submitted : | 1/21/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LANCET INDEMNITY RISK RETENTION GROUP INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
26-1479165 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Christopher | Teter | |||
Street Address | |||||
2810 West St. Isabel Street Suite 100 | |||||
City | State | Zip | |||
Tampa | FL | 33602 | |||
Phone | Ext | Fax | E-Mail Address | ||
(813) 290 - 8282 | 265 | cteter@lancetindemnity.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | EMILIO | GOMEZ-MADRAZO | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 11760 SW 40th Street | ||||
City | State | Zip Code | County | ||
Miami | FL | 33175 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
LR090905000201 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME67905 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Hospital/Institution | Kendall Regaional | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/17/2012 | 8/2/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Claimant sought treatment for cysts on her ovaries. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
A robotic, salpingo-oophorectomy was performed. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged improper performance of a surgery that resulted in a perforated bowel. | |||||
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 | ||||
4/16/2014 | 2014-10039-CA-01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 12/22/2015 | ||||
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 | |||||
12/22/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $112,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $17,900 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurer is unaware of what steps have been taken. |
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 : | M201575556 |
Claim Number : | FL-2014-6-17-14 |
Date Submitted : | 8/18/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PHYSICIANS CASUALTY RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-3867083 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kimberly | Pollick | |||
Street Address | |||||
510 Druid Road, Suite D | |||||
City | State | Zip | |||
Clearwater | FL | 33756 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 581 - 6400 | kim@physicianscasualty.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | EMILIO | GOMEZ-MADRAZO | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 11760 SW 40th Street, Suite 323 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33175 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PCX-2014-429 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME67905 | Gynecology - Minor 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 | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
SOUTH MIAMI HOSPITAL | 100154 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/17/2014 | 12/2/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The diagnosis that led to the treatment was myomata uterus and excessive menstrual bleeding. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Total abdominal hysterectomy with abdominal colpopexy. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleges that the surgery caused trigone bladder and ureter injury. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/27/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/30/2015 |
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 | $7,440 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $289,398 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Physician no longer does robotic surgery. Additionally, if he encounters a similar complication, he will contact a urologist for repair. |
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.
Does Dr. EMILIO GOMEZ-MADRAZO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. EMILIO GOMEZ-MADRAZO, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).