Department File Number : | M201782946 |
Claim Number : | 002725 |
Date Submitted : | 9/1/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
BERKLEY ASSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-1993236 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jennifer | Goodman | |||
Street Address | |||||
4820 Lake Brook Drive | |||||
City | State | Zip | |||
Glen Allen | VA | 23060 | |||
Phone | Ext | Fax | E-Mail Address | ||
(804) 525 - 1865 | (804) 525 - 1362 | jgoodman@verusins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JAVIER | ROMERO | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 8247 NW 194 Terr | ||||
City | State | Zip Code | County | ||
Miami | FL | 33015 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
VUMB0030543 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Registered Nurse | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9177095 | Anesthesiology |
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 | ||||
Other Outpatient Facility | Encore Plastic Surgery | ||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
5/12/2016 | 5/20/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Elective surgery - Liposuction in which provider administered anesthesia. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
During liposuction procedure, patient suffered a Fat Embolism and died. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Not applicable. | |||||
Principal Injury Giving Rise To The Claim | |||||
Fatal fat embolism. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/3/2016 | 2016028525CA01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 8/21/2017 | ||||
Other Defendants Involved in this Claim | |||||
Eres South Florida Plastic Surgery Inc Encore Plastic Surgery Inc Eres Cosmetic Surgery Inc. | |||||
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 | $35,387 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $2,500 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
No actions of malpractice found on the part of insured practitioner. |
Updates | |
No updates found. |
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Does Dr. JAVIER ROMERO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JAVIER ROMERO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).