Department File Number : | M201677905 |
Claim Number : | MCH-H-006427A |
Date Submitted : | 4/12/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Baptist Health South Florida | Primary | ||||
Insurer FEIN | Professional License Number | ||||
65-0267668 | 0000 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | NANCY | CARR | |||
Street Address | |||||
11440 SW 88th STREET | |||||
City | State | Zip | |||
MIAMI | FL | 33176 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Eric | Peterson | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1095 N.W. 14th Street, D46 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33136 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HPL/GL 2013-00 13/14 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME112997 | Surgery - Neurology - Including Child |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MIAMI CHILDREN'S HOSPITAL | 110199 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
8/30/2014 | 11/3/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient was admitted to undergo a partial debulking of a juvenile angiofibroma. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Not applicable. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis made of this patient. | |||||
Principal Injury Giving Rise To The Claim | |||||
An alleged failure to timely appreciate and treat complications in a then 14 year old male after undergoing partial debulking of juvenile angiofibroma resulting in some right-sided weakness. Allegations against this practitioner were not substantiated and the notice of intent was voluntarily withdrawn. | |||||
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 | 10/14/2015 | ||||
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 | |||||
No Payment Made | |||||
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 | $3,089 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,084 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Not applicable. |
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. ERIC PETERSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ERIC PETERSON, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).