Department File Number : | M201574368 |
Claim Number : | 10168121301 |
Date Submitted : | 4/22/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ADMIRAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
22-2235730 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Diane | M | Pucci | ||
Street Address | |||||
1000 Howard Boulevard | |||||
City | State | Zip | |||
Mt. Laurel | NJ | 08054 | |||
Phone | Ext | Fax | E-Mail Address | ||
(856) 857 - 3375 | (856) 429 - 3630 | dpucci@admiralins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Guy | E | Nicolas | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 800 N. Maitland Avenue, Suite 101 | ||||
City | State | Zip Code | County | ||
Maitland | FL | 32751 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CRLFL10168121301 | $250,000 | $15,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME72530 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Seminole | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Patient's Home | |||||
Name of Institution | Code | ||||
SOUTH SEMINOLE HOSPITAL | 100263 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/1/2013 | 4/21/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
DIFFICULTIES WITH RECURRENT CHEST PAIN -LIKELY ESOPHAGEAL SPASM | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
04-05-2013 - REFERRED TO GASTROENTEROLOGIST FOR ANENDOSCOPY 04-11-2013 - ENDOSCOPY PROCEDURE WASPERFORMED. 04-21-2013 - COLLAPSED AT HOME TAKEN TOHOSPITAL | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
WRONG DIAGNOSIS | |||||
Principal Injury Giving Rise To The Claim | |||||
FAILURE IN REFERRAL OR CONSULTATION - CAUSE OF DEATH WASMYOCARDIAL INFARCTIOND | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 3/3/2015 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
3/3/2015 |
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
NONE |
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. GUY E NICOLAS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. GUY E NICOLAS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).