Department File Number : | M201990488 |
Claim Number : | NEWSPC000212007 |
Date Submitted : | 11/4/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
LIBERTY INSURANCE UNDERWRITERS INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
22-2227331 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Julie | Hamilton | |||
Street Address | |||||
615 Crescent Executive Court, Suite 212 | |||||
City | State | Zip | |||
Lake Mary | FL | 32746 | |||
Phone | Ext | Fax | E-Mail Address | ||
(321) 972 - 0121 | juliehamilton@hamlinandburton.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Mari | Donofrio | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 2675 N. Andrews Ave | ||||
City | State | Zip Code | County | ||
Wilton Manors | FL | 33311 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
AHY847359002 | $200,000 | $600,000 | |||
Profession or Business | Other Profession or Business | ||||
Registered Nurse | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ARNP9253622 | General Preventative Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Nursing Home | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
5/15/2016 | 12/10/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Left above the knee amputation and sepsis | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Failure to recognize sepsis resulting in amputation of the left leg | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Sepsis and amputation of left leg | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 10/18/2019 | ||||
Other Defendants Involved in this Claim | |||||
Firaz R. Hosein, DO, PA HOSEIN, FIRAZ R | |||||
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 | |||||
9/11/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $19,026 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Unknown |
Updates | |
No updates found. |
Does Dr. MARI DONOFRIO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARI DONOFRIO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).