| Department File Number : | M201887290 |
| Claim Number : | 213348 |
| Date Submitted : | 12/17/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PROASSURANCE CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 38-2317569 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Denise | Stokes | |||
| Street Address | |||||
| 100 Brookwood Place | |||||
| City | State | Zip | |||
| Birmingham | AL | 35209 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (205) 802 - 4790 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | KAMAR | GODDER | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5955 Ponce De Leon Blvd | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33146 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP37267 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME117214 | Hematology - 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 | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/4/2011 | 7/5/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| recurrence of acute lymphoblastic leukemia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| followup and treatment following bone marrow transplant | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Plaintiffs alleged failure to appropriately monitor for signs of recurrence; however, plaintiffs took the child back to Nasasu, not returning for monitoring or treatment. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 12/10/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Kidz Medical Services, Inc. | |||||
| 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 | |||||
| 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 | $10,977 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $3,305 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured discussed case with defense counsel, insurance personnel, and medical experts. | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 12/17/2018 3:53:26 PM | |||||||||
| Reason for Change: | Updated ALAE information | |||||||||
| ||||||||||
Does Dr. KAMAR GODDER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KAMAR GODDER, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).