| Department File Number : | M201782916 |
| Claim Number : | 9941.248 |
| Date Submitted : | 8/28/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| SOUTH PINELLAS MEDICAL TRUST | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-6599936 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Andrew | L | Wallace | ||
| Street Address | |||||
| 341 3rd Street S | |||||
| City | State | Zip | |||
| St. Petersburg | FL | 33701 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 822 - 4600 | (727) 822 - 4665 | awallacespmt@gmail.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Erasmo | A | Passaro | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1607 Dr. Martin Luther King Jr. Street N | ||||
| City | State | Zip Code | County | ||
| St. Petersburg | FL | 33704 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 49630-16 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME67462 | Neurology - Including Child - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Patient's Home | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Patient's Home | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/12/2015 | 11/29/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Suspected seizures. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Reaction to prescribed medication. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None by Dr. Passaro. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Stevens Johnson Syndrome burns. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 8/10/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Florida Center for Neurology, Inc. Ziemba, M.D., Kristine S | |||||
| 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 | |||||
| 8/10/2017 | |||||
| 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 | $8,602 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Based on Dr. Passaro's and his expert's positive review, none deemed necessary at this time. | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 8/28/2017 5:50:17 PM | ||||||
| Reason for Change: | Added defense costs. | ||||||
| |||||||
| Date of Change: | 8/28/2017 6:00:48 PM | ||||||
| Reason for Change: | Correct defense costs. | ||||||
| |||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. ERASMO A PASSARO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ERASMO A PASSARO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).