| Department File Number : | M201575466 |
| Claim Number : | HM160958 |
| Date Submitted : | 8/7/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| COLUMBIA CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 47-0490411 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Marina | Miranda | |||
| Street Address | |||||
| 333 S Wabash Ave | |||||
| City | State | Zip | |||
| Chicago | IL | 60604 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (312) 822 - 2261 | marina.miranda@cna.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Hugo | Gonzalez | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 3661 S Miami Ave, Ste 901 | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33133 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| NSD 4022456181 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME34604 | Physicians or Surgeons | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| MERCY HOSPITAL, INC. | 100061 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/8/2008 | 2/14/2011 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Admitted with shortness of breath and hypoxia; diagnosis was congestive heart failure. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Pulmonary function study, | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Failure to assess/treat groin wound resulting in sepsis;death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/24/2011 | 10-29220 CA05 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 7/14/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| Mercy Hospital Inc Mercy Outpatient Services | |||||
| 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 | |||||
| 6/16/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $5,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $76,625 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $8,776 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $5,000 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Enforcing guidelines and policies to prevent risks. | |||||||||||||||||||||
| 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. HUGO GONZALEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. HUGO GONZALEZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).