Department File Number : | M201472410 |
Claim Number : | 183329 |
Date Submitted : | 5/16/2016 |
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 | Tracy | M | Harris | ||
Street Address | |||||
100 Brookwood Place | |||||
City | State | Zip | |||
Birmingham | AL | 35209 | |||
Phone | Ext | Fax | E-Mail Address | ||
(205) 439 - 7932 | tharris@proassurance.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lazaro | Bouza | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 4370 SW 160 Ave | ||||
City | State | Zip Code | County | ||
Miami | FL | 33185 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MP35423 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME42893 | Gastroenterology - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Dade | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
KENDALL ENDOSCOPY AND SURGERY CENTER | 14960457 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/14/2011 | 1/14/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient underwent colonoscopy. 7mm polyp found in transverse colon. Removed with cauterized biopsy. Pt presented to ED next day. Diagnosed with perforated colon. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient underwent colonoscopy. 7mm polyp found in transverse colon. Removed with cauterized biopsy. Pt presented to ED next day. Diagnosed with perforated colon. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient underwent colonoscopy. 7mm polyp found in transverse colon. Removed with cauterized biopsy. Pt presented to ED next day. Diagnosed with perforated colon. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/15/2013 | 13-17280CA04 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 10/2/2014 | ||||
Other Defendants Involved in this Claim | |||||
Kendall Healthcare Group, LTD | |||||
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 | |||||
10/14/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,113 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $19,622 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $150,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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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: | 11/14/2014 2:34:13 PM | |||||||||
Reason for Change: | updated financials | |||||||||
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Date of Change: | 12/17/2014 10:31:00 AM | |||||||||
Reason for Change: | updated | |||||||||
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Date of Change: | 1/14/2015 3:40:46 PM | |||||||||
Reason for Change: | updated financials | |||||||||
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Date of Change: | 5/16/2016 1:23:30 PM | |||||||||
Reason for Change: | Updated non economic loss information. | |||||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Department File Number : | M201575464 |
Claim Number : | 186459 |
Date Submitted : | 7/13/2016 |
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 | dstokes@proassurance.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lazaro | Bouza | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 4370 SW 160 Ave | ||||
City | State | Zip Code | County | ||
Miami | FL | 33185 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MP35423 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME42893 | Gastroenterology - 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 Outpatient Facility | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Operating Suite | |||||
Date of Occurrence | Date Reported to Insurer | ||||
8/23/2012 | 5/2/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Routine colonoscopy with polyp removal | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Colonoscopy with polyp removal | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No Misdiagnosis Made | |||||
Principal Injury Giving Rise To The Claim | |||||
Colon perforation | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/17/2013 | 2013-27599-CA-01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 6/5/2015 | ||||
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 | |||||
6/10/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $67,788 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $40,169 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $125,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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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: | 5/4/2016 4:15:47 PM | ||||||||||||
Reason for Change: | Updated non economic loss information | ||||||||||||
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Date of Change: | 7/13/2016 5:09:58 PM | ||||||||||||
Reason for Change: | updated ALAE amounts | ||||||||||||
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Does Dr. LAZARO BOUZA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LAZARO BOUZA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).