Department File Number : | M201573456 |
Claim Number : | FL-TEG-08-ERP |
Date Submitted : | 2/11/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
APPLIED MEDICO-LEGAL SOLUTIONS RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
81-0603029 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Julie | Moore | |||
Street Address | |||||
101 E. Park Blvd. | |||||
City | State | Zip | |||
Plano | TX | 75074 | |||
Phone | Ext | Fax | E-Mail Address | ||
(866) 520 - 6896 | jmontague@bpmp.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jose | Santana | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 2626 Capital Medical Blvd. | ||||
City | State | Zip Code | County | ||
Tallahassee | FL | 32308 | Leon | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
G-AMS-115975-ERP | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME95767 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Leon | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/7/2013 | 12/4/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Neoplasm of the left cerebellum p producing a mass effect and hydrcepharlus with periventricular edema. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
CT of the brain | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Bronchitis and headache | |||||
Principal Injury Giving Rise To The Claim | |||||
Failure to diagnose brain tumor. | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/22/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
After arbitration is initiated or prior to suit being filed. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
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 | $12,542 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Reread of critical radiology reports. |
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 SANTANA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOSE SANTANA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).