Department File Number : | M201783128 |
Claim Number : | SHI-17-356781 |
Date Submitted : | 9/19/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CONTINENTAL CASUALTY COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-2114545 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kathy | A | Stockton | ||
Street Address | |||||
1900 W. LOOP S., STE. 1500 | |||||
City | State | Zip | |||
Houston | TX | 77027 | |||
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 | JESSICA | S | SOLA ACEVEDO | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 851 TRAFALGAR COURT, SUITE 300W | ||||
City | State | Zip Code | County | ||
MAITLAND | FL | 32751 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HAZ 4032218126-2 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME116044 | Anesthesiology |
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 | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
SOUTH SEMINOLE HOSPITAL | 100263 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/22/2014 | 1/10/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
ROTATOR CUFF SURGERY | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
ROTATOR CUFF SURGERY | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
COMPLICATIONS DURING SURGERY | |||||
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 | 8/2/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
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 | $7,736 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,169 | ||||||||||||||||||||
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. |
*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 S SOLA ACEVEDO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JESSICA S SOLA ACEVEDO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).