Department File Number : | M201678675 |
Claim Number : | SAM-IG-006950 |
Date Submitted : | 6/7/2016 |
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 | JOSE | NEGRIN EXPOSITO | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 975 Baptist Way | ||||
City | State | Zip Code | County | ||
Homestead | FL | 33030 | Monroe | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
SPL 1068 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME116415 | Internal Medicine - 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 | ||||
HOMESTEAD HOSPITAL (DADE) | 100125 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/16/2015 | 2/12/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to ED with complaints of headache and left-sided weakness. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
There was no operation, diagnostic or treatment procedure rendered causing the injury. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis of the patient's condition. | |||||
Principal Injury Giving Rise To The Claim | |||||
This physician was not involved in the care and treatment of the patient and the claim was voluntarily withdrawn by the claimant's attorney. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 3/6/2016 | ||||
Other Defendants Involved in this Claim | |||||
Fernandez, Pedro Williams, Lorna Miguelez, Manuel Frias, Juan Ahoubim, Daniel Baptist Hospital of Miami, Inc. Homestead Hospital | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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 | $37 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,072 | ||||||||||||||||||||
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. JOSE NEGRIN EXPOSITO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE NEGRIN EXPOSITO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).