| Department File Number : | M201884450 |
| Claim Number : | 253017 |
| Date Submitted : | 3/1/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-3014772 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kelly | Andrews | |||
| Street Address | |||||
| 12724 Gran Bay Parkway, W., Suite 400 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jose | Guzman | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1150 N 35 Avenue, Suite 605 | ||||
| City | State | Zip Code | County | ||
| Hollywood | FL | 33021 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 070330 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME60687 | Cardiovascular Disease - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Patient's Home | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Patient's Home | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/20/2003 | 2/26/2007 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The insured treated the patient for a number of years for her cardiac condition. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The patient suffered a heart attack at home. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/2/2007 | 0718547 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Broward | 2/1/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Integrated Care, LLC dba Cardiovascular Consultants of SO Fl | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| During trial, but before court verdict. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 2/1/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $220,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $244,827 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $103,626 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $220,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| 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. JOSE GUZMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE GUZMAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).