Department File Number : | M201677504 |
Claim Number : | MCH-H-006449B |
Date Submitted : | 3/8/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MIAMI CHILDREN'S HOSPITAL | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-0638499 | 4067 | ||||
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 | Gavin | A | Falk | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 3100 S.W. 62nd Avenue | ||||
City | State | Zip Code | County | ||
Miami | FL | 33160 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HPL/GL 2014-00 14/15 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
TRN19530 | Pediatrics - No Surgery |
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 | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/23/2014 | 11/25/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to the Emergency Room after a possible fall with seizures. | |||||
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. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to timely secure an airway as well as perform a Crichothyrotomy in a then 13 year old patient while he was in the Emergency Room resulting in a hypoxic-ischemic brain injury. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 2/3/2016 | ||||
Other Defendants Involved in this Claim | |||||
Malvezzi, Leopoldo Henao Mejia, Juanita Pediatric Specialty Grp dba Pediatric Specialist of America Miami Associates in Pediatric Surgery, Inc. | |||||
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 | $16,048 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,665 | ||||||||||||||||||||
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. GAVIN A FALK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. GAVIN A FALK, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).