Department File Number : | M201886715 |
Claim Number : | SAM-IG-007965 |
Date Submitted : | 10/12/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
SAMARITAN RISK RETENTION GROUP, INC. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3433505 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | NANCY | CARR | |||
Street Address | |||||
11440 SW 88th STREET | |||||
City | State | Zip | |||
MIAMI | FL | 33176 | |||
Phone | Ext | Fax | E-Mail Address | ||
(305) 274 - 4070 | (305) 274 - 2701 | carol.lobacz@nccrms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MIREN | A | DE URRESTI | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 5975 Sunset Drive, Suite 402 | ||||
City | State | Zip Code | County | ||
Miami | FL | 33143 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
SPL 1088 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME72002 | Family Physicians or General Practitioners - No 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 | ||||
Other Hospital/Institution | SMH - Brickell Urgent Care Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Brickell Urgent Care Center | ||||
Date of Occurrence | Date Reported to Insurer | ||||
8/6/2016 | 3/13/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Cervical strain and gastritis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
There was no operation, diagnostic or treatment procedure that caused injury. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
There was no misdiagnosis made of this patient's condition. | |||||
Principal Injury Giving Rise To The Claim | |||||
Three days after seen at the urgent care center, the patient was taken via EMS to a hospital with symptoms of a stroke. Counsel for the claimant alleged that a possible stroke should have been considered. These allegations were unsubstantiated and the claim against this physician was abandoned. | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/27/2018 | ||||
Other Defendants Involved in this Claim | |||||
South Miami Hospital | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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 | $117 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,353 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Not applicable. |
Updates | |
No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. MIREN A DE URRESTI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MIREN A DE URRESTI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).