Department File Number : | M201576167 |
Claim Number : | ERMA11MHA153385-B |
Date Submitted : | 10/26/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
EVEREST INDEMNITY INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
22-3520347 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
9821 Katy Freeway | |||||
City | State | Zip | |||
Houston | TX | 77024 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ISMAIL ADEBAYO | DANIA | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 3663 SOUTH MIAMI AVENUE | ||||
City | State | Zip Code | County | ||
MIAMI | FL | 33133 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
6500000237-111 | $500,000 | $500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME90745 | Emergency Medicine - No Major Surgery |
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 | ||||
Other Hospital/Institution | MERCY HOSPITAL - MIAMI | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
11/4/2009 | 10/6/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
GAS PAIN AND MILD CHEST PAIN | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEEN IN ER. VITALS TAKEN AND MEDICATED FOR VOMITING. VQ SCAN, DOPPLER WAS DONE. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
NO MISDIAGNOSIS | |||||
Principal Injury Giving Rise To The Claim | |||||
DEATH DUE TO AORTIC DISSECTION. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/3/2012 | 1205499CA13 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 10/26/2015 | ||||
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 subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
10/22/2015 |
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 | $31,815 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $713 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN. |
Updates | |
No updates found. |
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Does Dr. ISMAIL ADEBAYO DANIA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ISMAIL ADEBAYO DANIA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).