Department File Number : | M201575196 |
Claim Number : | 308396 |
Date Submitted : | 7/14/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | AUDRA | M | FLOYD | ||
Street Address | |||||
13450 WEST SUNRISE BLVD | |||||
City | State | Zip | |||
SUNRISE | FL | 33323 | |||
Phone | Ext | Fax | E-Mail Address | ||
(877) 320 - 0748 | 3111 | (866) 636 - 5421 | afloyd@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MARIO | R | PEREZ-RODRIGUEZ | ||
Insurer Type | Street Address of Practice | ||||
Licensed | P.O. BOX 470459 | ||||
City | State | Zip Code | County | ||
CELEBRATION | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0956067 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME72969 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lake | ||||
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 | ||||
Other | PHYSICIAN'S OFFICE | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/4/2012 | 7/22/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
BLEPHAROPLASTY | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
PATIENT UNDERWENT UPPER/LOWER BLEPHAROPLASTY. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
ALLEGED SCARRING AND DISFIGUREMENT. | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
11/3/2014 | 14-CA-1883 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lake | 7/7/2015 | ||||
Other Defendants Involved in this Claim | |||||
MARIO R. PEREZ, M.D., P.A. SUNCOAST PREMIER MEDICAL, LLC ROMERO-PEREZ, MD, ISMAEL E | |||||
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 | |||||
7/2/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $45,000 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $100,000 | ||||||||||||||||||||
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. |
*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 : | M201677515 |
Claim Number : | 321114 |
Date Submitted : | 3/9/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | AUDRA | M | FLOYD | ||
Street Address | |||||
13450 WEST SUNRISE BLVD | |||||
City | State | Zip | |||
SUNRISE | FL | 33323 | |||
Phone | Ext | Fax | E-Mail Address | ||
(877) 320 - 0748 | 3111 | (866) 636 - 5421 | afloyd@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MARIO | R | PEREZ-RODRIGUEZ | ||
Insurer Type | Street Address of Practice | ||||
Licensed | P.O. Box 470459 | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0956067 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME72969 | Internal Medicine - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lake | ||||
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 | ||||
5/26/2012 | 8/1/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to insured for consult of liposuction previously performed by another physician. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Insured performed "touch up" liposuction to patient's upper arms and thighs. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient unhappy with results. | |||||
Severity Of Injury | |||||
Emotional Only - Fright, no physical damage |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 2/23/2016 | ||||
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 | |||||
2/23/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $23,750 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $21,000 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $23,750 | ||||||||||||||||||||
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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MARIO R PEREZ-RODRIGUEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARIO R PEREZ-RODRIGUEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).