| Department File Number : | M201884905 |
| Claim Number : | 0AB198423 |
| Date Submitted : | 4/6/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HOMELAND INSURANCE COMPANY OF NEW YORK | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 52-1568827 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mike | Clark | |||
| Street Address | |||||
| 199 Scott Swamp Road | |||||
| City | State | Zip | |||
| Farmington | CT | 06032 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (860) 321 - 2544 | (877) 256 - 5067 | mclark@onebeacon.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jesus | Palacio | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1301 S. Main St | ||||
| City | State | Zip Code | County | ||
| Belle Glade | FL | 35439 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MFL0045980416 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME40794 | Internal Medicine - No 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 | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Doctors office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/2/2015 | 3/15/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Non-small cell lung cancer | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Presented to office several times with complaints of coughing up blood made to CRNA Nnamdie. Additional testing was not ordered. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None. Failure to diagnose | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Non-selectable lung cancer required chemotherapy and radiation treatment. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/24/2017 | 17-CA-009622 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 3/23/2018 | ||||
| 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 | |||||
| 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 | $16,801 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| The insured, Dr. Palacio, was voluntarily dismissed. | |||||||||||||||||||||
| Updates | |||||||||||||
| Date of Change: | 4/6/2018 1:32:13 PM | ||||||||||||
| Reason for Change: | Updates IE other practitioner involved in the suit, clerical error fix | ||||||||||||
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Does Dr. JESUS PALACIO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JESUS PALACIO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).