Department File Number : | M201576660 |
Claim Number : | 70043 |
Date Submitted : | 12/23/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-2813188 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Trisha | D | Bowles | ||
Street Address | |||||
245 Riverside Avenue | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (888) 974 - 6458 | claims@mymedmal.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Fernando | M | Kafie | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 5149 N 9th Ave, Suite G20 | ||||
City | State | Zip Code | County | ||
Pensacola | FL | 32504 | Escambia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707264 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME81407 | Surgery - Vascular |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Escambia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/29/2010 | 1/4/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Varicose Veins | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Left greater saphenous vein endovenous laser therapy and phlebectomy left lower extremity | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff alleged surgical object retained. | |||||
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 | ||||
4/8/2013 | 2013-CA-000642 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Escambia | 12/21/2015 | ||||
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 | |||||
Disposed of by Court | |||||
Court Decision | Other | ||||
Other | Dismissal for lack of prosecution | ||||
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 | $34,265 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None -- no liability on behalf of our 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 M KAFIE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. FERNANDO M KAFIE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).