Department File Number : | M201679354 |
Claim Number : | SAM-IG-006499 |
Date Submitted : | 8/4/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SAMARITAN RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3433505 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | NANCY | CARR | |||
Street Address | |||||
11440 SW 88th STREET | |||||
City | State | Zip | |||
MIAMI | FL | 33176 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JOHN | A | MORYTKO | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 8950 N. KENDALL DRIVE, SUITE 501 | ||||
City | State | Zip Code | County | ||
MIAMI | FL | 33176 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
SPL1073 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME68145 | Cardiovascular Disease - No Surgery |
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 | ||||
BAPTIST HOSPITAL OF MIAMI | 100008 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/6/2013 | 1/13/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
ATRIAL FIBRILLATION, CARDIOMYOPATHY, CHF, PULMONARY HYPERTENSION, DIABETES | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
THERE WAS NO OPERATION, DIAGNOSTIC OR TREATMENT PROCEDURE CAUSING INJURY. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
THERE WAS NO MISDIAGNOSIS OF THIS PATIENT. | |||||
Principal Injury Giving Rise To The Claim | |||||
FOLLOWING DISCHARGE AFTER CARDIOVERSION THE PATIENT COLLAPSED AT HOME, WAS RESUSCITATED AND EXPIRED TWO WEEKS LATER. THE CLAIMANT ATTORNEY ALLEGED INADEQUATE DISCHARGE EVALUATION. THIS ALLEGATION WAS UNSUPPORTED BY AN EXPERT AND THE NOTICE OF INTENT WAS VOLUNTARILY WITHDRAWN. | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 6/13/2016 | ||||
Other Defendants Involved in this Claim | |||||
MERA, FERNANDO ESPAILLAT, M.D., IVAN R BAPTIST HOSPITAL OF MIAMI | |||||
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 | |||||
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 | $6,243 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,334 | ||||||||||||||||||||
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 | |||||||||||||||||||||
NOT APPLICABLE |
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. JOHN A MORYTKO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN A MORYTKO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).