| Department File Number : | M201575865 |
| Claim Number : | SAM-IG-006549 |
| Date Submitted : | 9/22/2015 |
| 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 | Jose | Pagliery | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 9555 S.W. 162nd Avenue | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33196 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| SPL 1016 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME61622 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| WEST KENDALL BAPTIST HOSPITAL | 23960064 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/9/2013 | 2/25/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Tendonitis of the right shoulder, swelling of left third digit and nodule to the fourth metacarpal. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Not applicable. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Based upon the available information, it is unknown if there was a misdiagnosis of this patient. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Two days after seen in the ED, the patient was diagnosed with a myocardial infarction. This case was settled as a business decision to avoid potential excess exposure to the physician. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 8/24/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| West Kendall Baptist Hospital | |||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 8/24/2015 | |||||
| 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 | $27,050 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $12,349 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
| 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.
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
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Does Dr. JOSE PAGLIERY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE PAGLIERY, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).