Department File Number : | M201988659 |
Claim Number : | 70899-A |
Date Submitted : | 5/3/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-2813188 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dan | Dupre | |||
Street Address | |||||
76 S. Laura St. | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (888) 974 - 6458 | claims@medmaldirect.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JENNIFER | N | GURAM PORTER | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 836 Prudential Drive, Suite 1506 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32207 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707114 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME113333 | Surgery - Obstetrics |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
MEMORIAL HOSPITAL JACKSONVILLE | 100179 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/28/2016 | 4/17/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pregnancy and Delivery. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Vaginal delivery with post partum bleeding. | |||||
Diagnostic Code : | 05 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to fully remove products of conception. | |||||
Principal Injury Giving Rise To The Claim | |||||
Subsequent procedure required to correct pain and bleeding. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/19/2017 | 16-2017-CA-004535 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 4/11/2019 | ||||
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 | |||||
4/3/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $65,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $62,197 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Comprehensive review of post operative protocol and procedures. |
Updates | |
No updates found. |
Department File Number : | M201472429 |
Claim Number : | 14-06-70353-A |
Date Submitted : | 10/23/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-2813188 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | William | S | Bliss | ||
Street Address | |||||
1 Independent Drive | |||||
City | State | Zip | |||
Jacksonville | FL | 32202 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 482 - 4068 | (904) 354 - 4813 | saunders@mymedmal.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jennifer | N | Guram Porter | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 836 Prudential Drive Suite 1506 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32207 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL707114 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME113333 | Surgery - Obstetrics - Gynecology |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
BAPTIST MEDICAL CENTER AND WOLFSON | 100088 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/2/2014 | 6/20/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Vaginal bleeding. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Ultrasound. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to diagnose ectopic pregnancy. | |||||
Principal Injury Giving Rise To The Claim | |||||
Loss of fallopian tube. | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/13/2014 | ||||
Other Defendants Involved in this Claim | |||||
Baptist Medical Center | |||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
10/13/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $17,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $8,907 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Company personnel consulted with insured. |
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. JENNIFER N GURAM PORTER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JENNIFER N GURAM PORTER, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).