| Department File Number : | M201988402 |
| Claim Number : | 5500000145089119 |
| Date Submitted : | 4/8/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| little company of Mary Hospital | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-399333 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Michael | R | Fiorucci | ||
| Street Address | |||||
| 7268 Monarda Dr | |||||
| City | State | Zip | |||
| Sarasota | FL | 34238 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (269) 312 - 0301 | mbfiorucci@mac.com | ||||
| Insured Information | |||||
| Type | Entity Name | ||||
| Entity | Little company of mary hospital | ||||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 2800 W 95th Street | ||||
| City | State | Zip Code | County | ||
| Evergreen Park | IL | 60805 | Out of state | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 01 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Hospitals | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Out of state | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient 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 | ||||
| 11/20/2014 | 11/21/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Incarcerated Diaphragmatic Hernia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Laparoscopic converted to open repair of diaphragmatic hernia | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Hemopericardium secondary to tack placement at the time of surgery | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 11/19/2018 | 16L5347 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Out of state | 12/13/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Settlement Reached Prior to Pre-Suit Period | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 12/13/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $1,000,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| No longer using tacker for repair of diaphragmatic hernia | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. MICHAEL FIORUCCI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MICHAEL FIORUCCI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).