Department File Number : | M201885129 |
Claim Number : | SAM-IG-007608 |
Date Submitted : | 4/20/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SAMARITAN RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3433505 | |||||
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 | Fernando | Fernandez | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 975 Baptist Way | ||||
City | State | Zip Code | County | ||
Homestead | FL | 33033 | Monroe | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
SPL 1068 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME106569 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Monroe | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
HOMESTEAD HOSPITAL (DADE) | 100125 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Progressive Care Unit | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/30/2015 | 7/18/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Drug induced allergic reaction. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
None. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis of this patient. | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient was admitted to the hospital under services of physician for complaints of generalized swelling and rash. The patient was evaluated for possible Stevens Johnson Syndrome and transferred to another facility for further evaluation and treatment. This claim was settled on behalf of this practitioner without an admission of liability and as a business decision to avoid protracted litigation and potential personal exposure. | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 3/8/2018 | ||||
Other Defendants Involved in this Claim | |||||
Marin, Edgar Calvo, Ashley Baptist Hospital Homestead Hospital Olympia, LLP | |||||
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 | |||||
2/22/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $5,562 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $8,773 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $125,000 | ||||||||||||||||||||
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.
Department File Number : | M201782739 |
Claim Number : | 56520 |
Date Submitted : | 8/4/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Fernando | A | Fernandez | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1235 Reserve Way | ||||
City | State | Zip Code | County | ||
Naples | FL | 34105 | Lee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PRF 1412088 00 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME106569 | Hospitalists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Lee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
PHYSICIANS REGIONAL MEDICAL CENTER - COLLIER BOULEVARD | 23960057 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
6/11/2013 | 2/11/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Hydronephrosis with obstructing stone | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to obtain post-op CXR, EKG, & ABG | |||||
Principal Injury Giving Rise To The Claim | |||||
Respiratory arrest | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 7/24/2017 | ||||
Other Defendants Involved in this Claim | |||||
Outten, PA, Nicole Mahadevan, MD, Anand Jay, MD, Jonathan Hicks, PA, Sarah Zeitler, MD, Mitchell Physicians Regional Medical Center | |||||
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 | |||||
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 | $12,535 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $809 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
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. FERNANDO FERNANDEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. FERNANDO FERNANDEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).