| Department File Number : | M201678945 |
| Claim Number : | 2014FL9213 |
| Date Submitted : | 7/7/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PHYSICIANS CASUALTY RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 27-3867083 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jody | Schwahn | |||
| Street Address | |||||
| 401 Corbett Street, Suite 200 | |||||
| City | State | Zip | |||
| Clearwater | FL | 33756 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 581 - 6400 | jschwahn@physicianscasualty.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Ismael | Beloso | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 12780 Waterford Lake Parkway | ||||
| City | State | Zip Code | County | ||
| Orlando | FL | 32828 | Orange | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PCX-2014-241 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS10148 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Orange | ||||
| 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 | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/2/2013 | 11/25/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The treatment sought was laser eyebrow removal. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Removed eyebrows with a laser. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Allegations include injury to the patient's left eye causing asymmetrical pupils, halo vision and sensitivity to light when allegedly struck by a laser during the procedure. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 10/9/2015 | 2015-CA-008249 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Orange | 6/24/2016 | ||||
| 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 | |||||
| 7/6/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $4,490 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $3,845 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| No longer doing laser eyebrow removal. | |||||||||||||||||||||
| 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. ISMAEL BELOSO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ISMAEL BELOSO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).