Department File Number : | M201575922 |
Claim Number : | 11-005-AB-000508 |
Date Submitted : | 9/29/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
HEALTH CARE CASUALTY RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1994595 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Amber | Basra | |||
Street Address | |||||
8725 W. Higgins Rd. | |||||
City | State | Zip | |||
Chicago | IL | 60631 | |||
Phone | Ext | Fax | E-Mail Address | ||
(773) 864 - 8291 | (773) 864 - 8281 | abasra@claritygrp.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Maya | Stamboliyska | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 699 W Cocoa Beach Cswy | ||||
City | State | Zip Code | County | ||
Cocoa Beach | FL | 32931 | Brevard | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
11-PA-005-AB | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME81256 | Neurology - Including Child - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Brevard | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
CAPE CANAVERAL HOSPITAL | 100177 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/16/2010 | 11/30/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with complaint of abdominal pain and intermittent parasthesias. Physician recommended MRI to rule out cord lesion/irritation. MRI demonstrated congenital spinal stenosis and degenerative disc disease at multiple levels. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Myelogram revealed spinal canal compromise with incomplete myelographic block at T5-T6. Thoracic decompression laminectomy performed. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis but delay in diagnosis and treatment. | |||||
Principal Injury Giving Rise To The Claim | |||||
Status post multi-level thoracic decompression Patient had lower extremity weakness. | |||||
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 | ||||
3/21/2012 | 05-2011-CA-008505 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Brevard | 6/3/2015 | ||||
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 | |||||
8/11/2015 |
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 | $176,951 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Consultants recommendations must be reviewed by the pcp and action taken. |
Updates | |
No updates found. |
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Does Dr. MAYA STAMBOLIYSKA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MAYA STAMBOLIYSKA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).