Department File Number : M201680043 Claim Number : 2014FL111113 Date Submitted : 10/18/2016
Insurer Information Insurer Name Coverage Type PHYSICIANS CASUALTY RISK RETENTION GROUP, INC. Primary Insurer FEIN Professional License Number 27-3867083 Insurer Contact Information Type First Name MI Last Name Individual Kimberly Pollick Street Address 401 Corbett Street, Suite 200 City State Zip Clearwater FL 33756 Phone Ext Fax E-Mail Address (727) 581 - 6400 email@example.com
Insured Information Type First Name MI Last Name Individual Joseph Sabadish Insurer Type Street Address of Practice Licensed 8250 Bryan Dairy Road Suite 200 City State Zip Code County Largo FL 33778 Pinellas Policy Number Per Claim Policy Limits Aggregate Policy Limits PC-2014-339 $250,000 $750,000 Profession or Business Other Profession or Business Medical Doctor License Number Specialty Code & Classification Certification Number ME51326 Anesthesiology
Injured Person Information First Name MI Last Name Date of Birth Street Address Gender County where Injury Occurred F Pinellas City State Zip Code Location where injury occured Other location where injury occured Other Outpatient Facility The patient was injured during procedure Name of Institution Code TAMPA BAY REGIONAL SURGERY CENTER 14960483 Location of Institutional Injury Other Location of Institutional Injury Special Procedure Room Date of Occurrence Date Reported to Insurer 11/11/2013 11/3/2014
Diagnostic Information Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition Patient presented for colonoscopy. Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury Colonoscopy, not performed by insured. Diagnostic Code : Misdiagnosis Made, If Any, Of Patient's Actual Condition *NR Principal Injury Giving Rise To The Claim Patient underwent procedure without CO2 monitoring. Patient arrested under CRNA management resulting in hypoxic eschemic encephalopathy. The insured was not informed of a problem with the patient until after she arrested and Code was called. The patient suffered significant brain injury as a result. Severity Of Injury Permanent: Death.
Legal Information Date of Suit Circuit Court Case Number 1/20/2016 16-000359-CI County Suit Filed in Date of Final Disposition Pinellas 10/7/2016 Other Defendants Involved in this Claim Tampa Bay Regional Surgery Center SARC/Largo Endoscopy 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 8/10/2016
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 $10,665 All Other Loss Adjustment Expense Paid $4,645 Injured Person's Total Non-Economic Loss $0 Deductible $0 Injured Person's Total Economic Loss
Incurred to Date Anticipated Medical Expense $0 $0 Wage Loss $0 $0 Other Expenses $0 $0 Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely None taken as the insured was not made aware the patient was having trouble until after she arrested and code was called.
Updates No updates found. Print Return to Search Results Page *NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.