| Department File Number : | M201573163 |
| Claim Number : | 185328 |
| Date Submitted : | 5/5/2016 |
| 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 | Marcelo | A | Jimenez | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5503 S. Congress Avenue Suite 206 | ||||
| City | State | Zip Code | County | ||
| Atlantis | FL | 33462 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP75026 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME112292 | Cardiovascular Disease - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| 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 | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/14/2013 | 3/21/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient underwent ablation for atrial fibrillation. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient underwent ablation for atrial fibrillation and suffered stroke approximately 2 hours later. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient underwent ablation for atrial fibrillation and suffered stroke approximately 2 hours later. Patient claims procedure was unnecessary and anticoagulation was inadequate. | |||||
| 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 | ||||
| 8/1/2014 | 502014CA008983XXXX | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 1/2/2015 | ||||
| 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 | |||||
| 1/2/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $21,356 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $6,390 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
| 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: | 3/26/2015 2:02:37 PM | |||||||||
| Reason for Change: | Updated financial information | |||||||||
| ||||||||||
| Date of Change: | 7/6/2015 11:50:57 AM | |||||||||
| Reason for Change: | update ALAE | |||||||||
| ||||||||||
| Date of Change: | 7/7/2015 10:44:31 AM | |||||||||
| Reason for Change: | Update ALAE | |||||||||
| ||||||||||
| Date of Change: | 5/5/2016 4:28:15 PM | |||||||||
| Reason for Change: | Updated non economic loss report | |||||||||
| ||||||||||
*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 : | M201989223 |
| Claim Number : | 232344 |
| Date Submitted : | 12/13/2019 |
| 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 | Lauren | Archer | |||
| Street Address | |||||
| 100 Brookwood Place | |||||
| City | State | Zip | |||
| Birmingham | AL | 35209 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (205) 439 - 7921 | larcher@proassurance.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Marcelo | A | Jimenez | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 180 JFK Drive, Suite 311 | ||||
| City | State | Zip Code | County | ||
| Atlantis | FL | 33462 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP75026 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME112292 | Cardiovascular Disease - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| PALM BEACH GARDENS MEDICAL CENTER | 100176 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/13/2018 | 9/12/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| right sided atrial flutter | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| ablation for atrial flutter | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Plaintiff alleged that he suffered a puncture of the femoral vein during the procedure performed by our insured which resulted in a pseudoaneurysm, with the surgical repair causing a seroma | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Plaintiff alleged that he suffered a puncture of the femoral vein during the procedure performed by our insured which resulted in a pseudoaneurysm, with the surgical repair causing a seroma | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/10/2018 | 81892815 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 7/23/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| Florida Electrophysiology Associates, P.A. | |||||
| 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 | |||||
| 6/20/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $58,869 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $28,911 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $250,000 | ||||||||||||||||||||
| 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 | |
| No updates found. |
Does Dr. MARCELO A JIMENEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARCELO A JIMENEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).