| Department File Number : | M201576630 |
| Claim Number : | 70251 |
| Date Submitted : | 12/21/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 27-2813188 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Trisha | D | Bowles | ||
| Street Address | |||||
| 245 Riverside Avenue | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32202 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 482 - 4068 | (888) 974 - 6458 | claims@mymedmal.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jose | Erbella | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 606 South Blvd | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33606 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL707214 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME84834 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Manatee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| MANATEE MEMORIAL HOSPITAL | 100035 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Critical Care Unit | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/7/2012 | 10/2/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient was injured in a motor vehicle accident | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient's initial symptoms were not indicative of a surgical abdomen. However, later evidence revealed patient had internal injuries. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient died in hospital | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 4/15/2014 | 2014 ca 001661 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Manatee | 10/22/2015 | ||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| Other | Dismissal due to settlement by parties | ||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $40,799 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Risk Management conference with insured | |||||||||||||||||||||
| 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.
| Department File Number : | M201884582 |
| Claim Number : | 70593 |
| Date Submitted : | 3/13/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDMAL DIRECT INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 27-2813188 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | James | P | Lacey | ||
| Street Address | |||||
| 76 South Laura Street, Suite 900 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32202 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 482 - 4068 | (888) 974 - 6458 | claims@medmaldirect.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jose | Erbella | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 606 South Boulevard | ||||
| City | State | Zip Code | County | ||
| Tampa | FL | 33606 | Hillsborough | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL707214 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME84834 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Hillsborough | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| LAKEWOOD RANCH MEDICAL CENTER | 23960046 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/18/2014 | 10/5/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Abdominal pain. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Laparoscopic cholecystectomy. | |||||
| Diagnostic Code : | 06 | ||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Transection of the common bile duct during laparoscopic surgery. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/16/2015 | 15CA-8456 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 2/8/2018 | ||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| Other | Settled by the parties before trial. | ||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 2/21/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $37,178 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| None. | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
Does Dr. JOSE ERBELLA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE ERBELLA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).