| Department File Number : | M201781794 |
| Claim Number : | 1016858-04 |
| Date Submitted : | 8/21/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Lynn | Louthan | |||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Ft Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0778 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | JOSE | P | FERRER | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 8950 N Kendall Dr Ste 306W | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33176 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 767105 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME95087 | Gastroenterology - Minor 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 | ||||
| BAPTIST HOSPITAL OF MIAMI | 100008 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/2/2012 | 4/23/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Colo-rectal issues | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Hospitalization with diagnostic testing | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Discharge without completing hematology consult | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Stroke post discharge | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/26/2014 | 13-34027 CA 32 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 4/10/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Baptist Hospital of Miami Inc Szomstein MD, Marcos Marcos Szomstein MD PA Martel MD, Jerry Gastro Health PL dba Gastr Health Fein, MD, Steven G Oncology Heamtology Radiation Care LLC dba Advanced Medical Advanced Medical Specialties LLC | |||||
| 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 | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 4/10/2017 | |||||
| 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 | $91,569 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $55,151 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $137,500 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| n/a | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 8/17/2017 1:46:07 PM | |||||||||
| Reason for Change: | ALE UPDATE 8/17/2017 | |||||||||
| ||||||||||
| Date of Change: | 1/31/2018 2:09:16 PM | |||||||||
| Reason for Change: | ALE UPDATE 1/31/2018 | |||||||||
| ||||||||||
| Date of Change: | 8/21/2018 12:57:17 PM | |||||||||
| Reason for Change: | ALE UPADTE | |||||||||
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| Department File Number : | M201782153 |
| Claim Number : | 1024395-01 |
| Date Submitted : | 8/22/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Lynn | Louthan | |||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Ft Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0778 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jose | P | Ferrer | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 8950 N Kendall Dr Ste 306W | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33176 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 767105 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME95087 | Gastroenterology - Minor 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 Inpatient Facility | |||||
| Name of Institution | Code | ||||
| BAPTIST HOSPITAL OF MIAMI | 100008 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/28/2013 | 3/5/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Abdominal issues | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Inpatient monitoring / treatment | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Failure to diagnose ischemic bowel | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/24/2015 | 2015-CA-022074 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 5/10/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Rodriguez MD, Leunam J Gastro Health PL dba Gatro Health Roig MD, Andres I | |||||
| 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 | |||||
| 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 | $44,395 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $26,464 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| n/a | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 2/1/2018 2:23:08 PM | |||||||||
| Reason for Change: | ALE UPDATE 2/1/2018 | |||||||||
| ||||||||||
| Date of Change: | 8/22/2018 1:52:47 PM | |||||||||
| Reason for Change: | ALE UPDATE | |||||||||
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Does Dr. JOSE P FERRER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE P FERRER, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).