Department File Number : | M201576444 |
Claim Number : | 13-03-70163-A |
Date Submitted : | 12/3/2015 |
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 | Francis | E | Salazar | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 3700 Washington Street, Suite 404 | ||||
City | State | Zip Code | County | ||
Hollywood | FL | 33021 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707187 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS10490 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
MEMORIAL HOSPITAL WEST | 111527 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/18/2011 | 3/28/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Perforated colon | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Colonoscopy performed by another physician | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Diagnosed with diverticulitis; however, patient's colon had been perforated during colonoscopy | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient's colon was perforated during colonoscopy performed by another physician | |||||
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 | ||||
7/25/2013 | 13-017770(13) | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 8/10/2015 | ||||
Other Defendants Involved in this Claim | |||||
Snow, Jeffrey Garcia, Alvaro | |||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
11/10/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $11,668 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $44,596 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurer consulted with Provider |
Updates | |
No updates found. |
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Does Dr. FRANCIS E SALAZAR, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. FRANCIS E SALAZAR, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).