Department File Number : | M201885932 |
Claim Number : | 1823703 |
Date Submitted : | 7/13/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
URGENT CARE ASSURANCE COMPANY RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-8725275 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Pamela | M | Burke | ||
Street Address | |||||
615 Crescent Executive Court, Suite 212 | |||||
City | State | Zip | |||
Lake Mary | FL | 32746 | |||
Phone | Ext | Fax | E-Mail Address | ||
(828) 255 - 5171 | (321) 972 - 0122 | pamelaburke@hamlinandburton.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Larisa | Paul | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 14530 S. Military Trail, Suite A1-A5 | ||||
City | State | Zip Code | County | ||
Delray Beach | FL | 33484 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
UCAC086-17 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Osteopathic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
OS14105 | Internal Medicine - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Express Docs, LLC | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Outpatient urgent care center | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/6/2017 | 3/14/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Right 5th metatarsal fracture. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Failure to diagnose right 5th metatarsal fracture. | |||||
Diagnostic Code : | S92.351A | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Misdiagnosed as a sprain. | |||||
Principal Injury Giving Rise To The Claim | |||||
Due to delay in diagnosis, patient alleges non-displaced fracture progressed to displaced fracture requiring non-weightbearing for 2 months and use of bone stimulator. | |||||
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 | 6/26/2018 | ||||
Other Defendants Involved in this Claim | |||||
Express Docs, LLC | |||||
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 | |||||
7/9/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $626 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,975 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $1,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insured will send x-rays out for over-read to radiologist. |
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. LARISA PAUL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LARISA PAUL, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).