| Department File Number : | M201987633 |
| Claim Number : | 38-01-2017-0045A |
| Date Submitted : | 1/17/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MOUNT SINAI MEDICAL CENTER | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-0624424 | 4066 | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | NANCY | CARR | |||
| Street Address | |||||
| 11440 SW 88th STREET | |||||
| City | State | Zip | |||
| MIAMI | FL | 33176 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kfir | Ben-David | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 4306 Alton Road | ||||
| City | State | Zip Code | County | ||
| Miami Beach | FL | 33140 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MSMC SIR1 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME98890 | Surgery - General | ||||
| 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 | ||||
| MOUNT SINAI MEDICAL CENTER | 100034 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/16/2017 | 12/27/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Enlarging retroperitoneal Schwannoma. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Resection of enlarging retroperitoneal Schwannoma tumor just under the left kidney and involving part of the left renal artery. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis made of this patient. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Transection injury of left ureter with alleged delayed diagnosis and repair with multiple hospitalizations as a sequellae of nephrostomy and ureter injury. | |||||
| 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 | 8/20/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| 8/29/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $350,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $18,589 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $16,043 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $350,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Reviewed in accordance with hospital peer review policy and procedure. | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201886343 |
| Claim Number : | 38-01-2016-0038A |
| Date Submitted : | 9/6/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MOUNT SINAI MEDICAL CENTER | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-0624424 | 4066 | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | NANCY | CARR | |||
| Street Address | |||||
| 11440 SW 88th STREET | |||||
| City | State | Zip | |||
| MIAMI | FL | 33176 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kfir | Ben-David | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 4306 Alton Road | ||||
| City | State | Zip Code | County | ||
| Miami Beach | FL | 33139 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| SIR1 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME98890 | Surgery - General | ||||
| 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 | ||||
| MOUNT SINAI MEDICAL CENTER | 100034 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/8/2015 | 8/19/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Esophageal cancer, Barretts esophagus. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Minimally invasive esophagogastrectomy with cervical esophagogastric anastomosis, thoracic duct ligation, laparoscopic vagotomy for surgical resection of esophageal adenocarcinoma invading the muscularis mucosa. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was no misdiagnosis of this patient. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Secondary reconstructive surgical procedure at another facility, after which patient complained of multiple daily food regurgitation, vomiting, food obstructions, dilations, allegedly due to surgery selection versus alternative surgical options not offered. | |||||
| 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 | 2/8/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| No Payment Made | |||||
| 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 | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Not applicable. | |||||||||||||||||||||
| 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. KFIR BEN-DAVID, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KFIR BEN-DAVID, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).