| Department File Number : | M201884890 |
| Claim Number : | MM268633 |
| Date Submitted : | 3/29/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EVANSTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2950161 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | CRYSTAL | L | ALSTONBAYTON | ||
| Street Address | |||||
| 4600 COX ROAD | |||||
| City | State | Zip | |||
| GLEN ALLEN | VA | 23060 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (804) 864 - 3731 | CALSTONBAYTON@MARKELCORP.COM | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ENRIQUE | JIMENEZ | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2776 Cleveland Ave | ||||
| City | State | Zip Code | County | ||
| FORT MYERS | FL | 33901 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MM268633 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME114377 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Duval | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| SHANDS HOSPITAL | 100113 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/21/2013 | 11/6/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| FL notice of potential claim arising out of Patient was admitted on Sept. 21, 2013 with a sore throat, inability to swallow, drooling, difficulty in speaking for the past 3 days and he was unable to take antibiotics orally. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The patient expired on Sept. 29, 2013 with a final diagnosis of peritonsillar abscess, cardiac arrest and anoxic encephalopathy. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| NO MISDIAGNOSIS | |||||
| Principal Injury Giving Rise To The Claim | |||||
| FAILURE TO TREAT FOR PERITONSILLAR ABSCESS S/P PATIENT'S DEATH | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/11/2015 | 16-2015-CA-006808 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Duval | 11/1/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| AL ASHHAB, AIHAM CHERIPALLI, PRAVEEN | |||||
| 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 | |||||
| 11/15/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $750,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $143,796 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $11,489 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $63,911 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| NONE | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. ENRIQUE JIMENEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ENRIQUE JIMENEZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).