Department File Number : | M201472865 |
Claim Number : | 15003-11866 |
Date Submitted : | 12/8/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SOUTH PINELLAS MEDICAL TRUST | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6599936 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Gail | Moulds | |||
Street Address | |||||
100 Second Avenue South Suite 902 | |||||
City | State | Zip | |||
St. Petersburg | FL | 33701 | |||
Phone | Ext | Fax | E-Mail Address | ||
(727) 551 - 0000 | (727) 896 - 5532 | GMoulds@deaconandmoulds.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Juan | A | Escobales | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2815 First Avenue North | ||||
City | State | Zip Code | County | ||
St. Petersburg | FL | 33713 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
46095-14 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME27676 | Family Physicians or General Practitioners - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pinellas | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
2/1/2009 | 5/20/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Diabetes, Kidney Failure, Calciphylaxis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Diabetes management; claimants failure to follow up with recommended specialists | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
Calciphylaxis | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 11/19/2014 | ||||
Other Defendants Involved in this Claim | |||||
Alexander, Vladimire Juan A Escobales MD PA d/b/a E & E Family Medicine Physician | |||||
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 | |||||
12/4/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $95,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $19,128 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,469 | ||||||||||||||||||||
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 | |||||||||||||||||||||
none needed |
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. JUAN A ESCOBALES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JUAN A ESCOBALES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).