Department File Number : | M201680687 |
Claim Number : | 333985 |
Date Submitted : | 12/20/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Juan | J | Perez | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 805 Century Medical Drive Suite A | ||||
City | State | Zip Code | County | ||
Titusville | FL | 32796 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0072012 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME60095 | Pulmonary Diseases - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Brevard | ||||
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 | ||||
Other | Physicians Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/14/2013 | 9/14/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient was treated for general wellness. An MRI showed a mass at the anterior margin of supresellar cistern of the RT. The patient suffered significant vision loss. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Alleged failure to follow up on neurology referral resulting in visual loss. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to monitor. | |||||
Principal Injury Giving Rise To The Claim | |||||
Visual impairment. | |||||
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 | ||||
2/26/2016 | CA-014025 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Brevard | 11/29/2016 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
11/29/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $174,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $31,535 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,982 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $174,500 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Does Dr. JUAN J PEREZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JUAN J PEREZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).