| Department File Number : | M201987566 |
| Claim Number : | 215872 |
| Date Submitted : | 1/11/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PROASSURANCE INDEMNITY COMPANY, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 63-0720042 | |||||
| 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 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Martin | N | Zaiac | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4308 Alton Road, suite 750 | ||||
| City | State | Zip Code | County | ||
| Miami Beach | FL | 33140 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP38916 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME52008 | Dermatology - All Other | ||||
| 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 | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/5/2016 | 10/21/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Biopsies were performed on the nose and inner elbow area. The pathology lab mixed up the biopsies, causing it to seem basil cell carcinoma was on the arm instead of the nose. The mix up was not corrected in the chart until after a Mohs procedure was performed on the arm for basil cell carcinoma instead of the nose. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Mohs procedure performed on arm instead of nose. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Biopsies were mixed up in the pathology lab and patient had a Mohs procedure on her arm instead of her nose leaving a scar. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The Mohs procedure done on the arm instead of the nose and it left a scar on the arm of the patient. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 10/4/2017 | 2017-22331 CA 01 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 12/17/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Arthur S Colsky MD d/b/a skin Cneter of South Miami Poochareon, Varee d/b/a Greater Miami skin and Laser Center Martin N Zaiac MD PA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within 90 days of suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 1/3/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $32,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $23,681 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $4,469 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $32,500 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Insrued discussed case with defense counsel, insurance personnel, and medical experts. | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201573817 |
| Claim Number : | 180269 |
| Date Submitted : | 7/6/2015 |
| 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 | Joe | H | Grasse | ||
| Street Address | |||||
| 100 Brookwood Place | |||||
| City | State | Zip | |||
| Birmingham | AL | 35209 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (205) 439 - 7969 | jgrasse@proassurance.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Martin | N | Zaiac | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4308 Alton Road, Suite 750 | ||||
| City | State | Zip Code | County | ||
| Miami Beach | FL | 33140 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP38916 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME52008 | Dermatology - 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 | ||||
| Physician's Office | |||||
| 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 | ||||
| 7/7/2011 | 8/17/2012 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient alleges burns and disfigurement resulting from laser tattoo removal, performed by Physician's Assistant. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient alleges burns and disfigurement resulting from laser tattoo removal, performed by Physician's Assistant | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient alleges burns and disfigurement resulting from laser tattoo removal, performed by Physician's Assistant | |||||
| 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 | ||||
| 2/25/2013 | 13-05679CA02 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 2/16/2015 | ||||
| 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 | |||||
| Disposed of by Arbitration | |||||
| 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 | $60,674 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $27,337 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured discussed case with defense counsel, insurance personnel, and medical experts. | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 3/26/2015 1:19:18 PM | |||||||||
| Reason for Change: | Updated financial information | |||||||||
| ||||||||||
| Date of Change: | 7/6/2015 11:18:24 AM | |||||||||
| Reason for Change: | update ALAE | |||||||||
| ||||||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MARTIN N ZAIAC, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARTIN N ZAIAC, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).