Department File Number : | M201885649 |
Claim Number : | EPS2016-003 |
Date Submitted : | 6/16/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
GABLES RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
27-5467619 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Meerali | Patel | |||
Street Address | |||||
5955 Ponce de Leon Blvd | |||||
City | State | Zip | |||
Coral Gables | FL | 33146 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 661 - 1515 | 231 | (305) 662 - 3723 | mpatel@kidzmedical.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JESSICA | MORLOK PRINCE | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 5955 Ponce de Leon Blvd | ||||
City | State | Zip Code | County | ||
Coral Gables | FL | 33146 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
eps016-003 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME99016 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Patient's Home | |||||
Name of Institution | Code | ||||
SAINT MARY'S HOSPITAL | 100010 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Home | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/25/2015 | 9/8/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Meningitis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient arrived at hospital via fire rescue due to possible seizure and high fever | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Delay in diagnosing meningitis - was diagnosed 5 days after discharge | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 2/14/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
After arbitration is initiated or prior to suit being filed. | |||||
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 | |||||
2/14/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Review of discharge protocol and differential diagnosis for meninigitis |
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. JESSICA MORLOK PRINCE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JESSICA MORLOK PRINCE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).