Department File Number : | M201575819 |
Claim Number : | 5149294-01 |
Date Submitted : | 9/21/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Susan | K | Spielman | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MARLENE | E | CEPEDA-GOODWIN | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1290 W Magnolia Circle | ||||
City | State | Zip Code | County | ||
Delray Beach | FL | 33445 | Palm Beach | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
A11101 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Physician Assistant | ||||
License Number | Specialty Code & Classification | Certification Number | |||
PA9104445 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Premier Urgent Care Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Exam room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/12/2010 | 4/12/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Chest pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Recommendation to emergency department for evaluation | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Patient did not go to emergency department | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/20/2012 | 12009876-168 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 4/2/2013 | ||||
Other Defendants Involved in this Claim | |||||
Gibson MD, Xunda A Xunda A Gibson MD Inc Premier Urgent Care Center LLC | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $24,047 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,191 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | |
No updates found. |
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Does Dr. MARLENE E CEPEDA-GOODWIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARLENE E CEPEDA-GOODWIN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).