Department File Number : | M201782462 |
Claim Number : | 1625971 (Penate, MD) |
Date Submitted : | 6/29/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
JSA Healthcare Corporation | Primary | ||||
Insurer FEIN | Professional License Number | ||||
87-040885 | 1053384214 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Brenda | Warren | |||
Street Address | |||||
17107 Longacres Lane | |||||
City | State | Zip | |||
Odessa | FL | 33556 | |||
Phone | Ext | Fax | E-Mail Address | ||
(813) 792 - 1588 | (321) 972 - 0122 | brendawarren@hamlinandburton.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Israel | Penate | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 9750 NW 33rd Street; Suite 212 | ||||
City | State | Zip Code | County | ||
Coral Springs | FL | 33065 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL-1603317 00 01 | $250,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME94617 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
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 | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/6/2016 | 9/24/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
A-Fib - Monitoring and maintaining therapeutic INR levels. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Incorrect dosage of Coumadin prescribed due to a scrivener error by the medical assistant. | |||||
Diagnostic Code : | K92.2 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis made | |||||
Principal Injury Giving Rise To The Claim | |||||
Coumadin toxicity with an acute episode of supra therapeutic INR resulting in a slow GI bleed requiring hospitalization / blood transfusions. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 6/23/2017 | ||||
Other Defendants Involved in this Claim | |||||
Healthcare Partners South Florida, LLC | |||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $8,955 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,730 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk Management reviewed policies and procedures. |
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. ISRAEL PENATE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ISRAEL PENATE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).