Department File Number : | M202092453 |
Claim Number : | 392145 |
Date Submitted : | 5/14/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Angela | LaFrance | |||
Street Address | |||||
12724 Gran Bay Pkwy., W., Suite 400 | |||||
City | State | Zip | |||
JACKSONVILLE | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3045 | alafrance@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Guillermo | Varela | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 806 Douglas Road, Suite 820 | ||||
City | State | Zip Code | County | ||
Coral Gables | FL | 33134 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0734400 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME92884 | Hospitalists |
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 | ||||
MEMORIAL HOSPITAL JACKSONVILLE | 100179 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Critical Care Unit | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/11/2018 | 11/8/2019 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to the ED in diabetic ketoacidosis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The insured admitted patient to ICU and made the appropriate orders and consults. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to timely respond to a potential lower limb vascular injury. | |||||
Principal Injury Giving Rise To The Claim | |||||
Above the knee amputation. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/26/2020 | 2020-CA-001835 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 5/7/2020 | ||||
Other Defendants Involved in this Claim | |||||
Memorial Hospital of Jacksonville | |||||
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 | |||||
5/7/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $12,553 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,848 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient safety referral is made if appropriate. |
Updates | |
No updates found. |
Does Dr. GUILLERMO VARELA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. GUILLERMO VARELA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).