Department File Number : | M201678334 |
Claim Number : | 1016179-01 |
Date Submitted : | 2/20/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Isaac | S | Vergara | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 6905 Medical View Lane | ||||
City | State | Zip Code | County | ||
Zephyrhills | FL | 33542 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
748112 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME87592 | Surgery - Opthalmology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Marion | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/7/2011 | 9/23/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Vision issues | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Intraocular lens into the sulcus | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Used one piece lens rather than three piece lens | |||||
Principal Injury Giving Rise To The Claim | |||||
Diminished vision in left eye | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/14/2014 | 42-2014-CA-000630-A | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 5/3/2016 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
5/2/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $60,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $28,521 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,383 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $55,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 8/11/2016 9:58:18 AM | |||||||||
Reason for Change: | ALE UPDATED 8/11/2016 | |||||||||
| ||||||||||
Date of Change: | 2/20/2017 1:44:07 PM | |||||||||
Reason for Change: | ALE UPDATE 2/20/2017 | |||||||||
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Does Dr. ISAAC S VERGARA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ISAAC S VERGARA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).