Department File Number : | M201884681 |
Claim Number : | 105-13-0641 |
Date Submitted : | 3/16/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FAIR AMERICAN INSURANCE AND REINSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
13-3333610 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Vanessa | Mejia | |||
Street Address | |||||
1401 Wilson Blvd., Ste. 700 | |||||
City | State | Zip | |||
Arlington | UT | 22209 | |||
Phone | Ext | Fax | E-Mail Address | ||
703907381 | bates@prms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Miguel | Mandoki | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 250 Catalonia Ave., Ste. 607 | ||||
City | State | Zip Code | County | ||
Coral Gables | FL | 33134 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
IN-FCo00-033317957 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME45847 | Psychiatry - All Other |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Palm Beach | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Patient's Home | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/24/2013 | 10/23/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Schizoaffective disorder, Bipolar disorder | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
outpatient psychiatrist | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to recognize suicidal ideation | |||||
Principal Injury Giving Rise To The Claim | |||||
Suicide | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/17/2014 | 2014CA014731 AH | ||||
County Suit Filed in | Date of Final Disposition | ||||
Palm Beach | 3/16/2018 | ||||
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 | |||||
10/19/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $269,132 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None. |
Updates | |
No updates found. |
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Does Dr. MIGUEL MANDOKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MIGUEL MANDOKI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).