Department File Number : | M201783195 |
Claim Number : | CLFL4835A |
Date Submitted : | 9/25/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CENTURION MEDICAL LIABILITY PROTECTIVE RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1145017 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | LETIA | S | SHELTON | ||
Street Address | |||||
3100 S GESSNER ROAD STE 600 | |||||
City | State | Zip | |||
HOUSTON | TX | 77084 | |||
Phone | Ext | Fax | E-Mail Address | ||
(713) 353 - 1624 | LETIA.SHELTON@ESIS.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | JOSE | DE JESUS-CARBUCCIA | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1620 S CONGRESS AVE STE 100 | ||||
City | State | Zip Code | County | ||
PALM SPRINGS | FL | 33461 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL4835 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME43914 | Anesthesiology - All Other |
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 | ||||
Other Outpatient Facility | SURGERY CENTER | ||||
Name of Institution | Code | ||||
OUTPATIENT PLASTIC SURGERY CENTER | 14960352 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/28/2016 | 6/28/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
UNKNOWN SURGERY, INTUBATION | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
INTUBATION PLACEMENT | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
NO MISDIAGNOSIS MADE | |||||
Principal Injury Giving Rise To The Claim | |||||
tracheal laceration from intubation during surgical procedure | |||||
Severity Of Injury | |||||
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/13/2016 | 9999999 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Palm Beach | 7/31/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Award for plaintiff. | |||||
Date of Payment | |||||
7/31/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $72,450 | ||||||||||||||||||||
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 | |||||||||||||||||||||
UNKNOWN AT THIS TIME |
Updates | |
No updates found. |
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Does Dr. JOSE DE JESUS-CARBUCCIA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE DE JESUS-CARBUCCIA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).