| Department File Number : | M201781461 |
| Claim Number : | FL0472 |
| Date Submitted : | 3/17/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yvette | de la Morena | |||
| Street Address | |||||
| 1250 S. Pine Island Road Suite 300 | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 923 - 1900 | ymorena@hugroups.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mitchell | Samuels | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4651 Sheridan Street, Suite 270 | ||||
| City | State | Zip Code | County | ||
| Hollywood | FL | 33021 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 129-011 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS5015 | Pediatrics - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| MEMORIAL HOSPITAL PEMBROKE | 100230 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/17/2016 | 8/2/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Treatment sought for headache, fever, abdominal pain and rash on lower extremities | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Alleged failure to treat | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death of patient | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/15/2016 | 16-012348 (05) | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Broward | 2/14/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Childrens Medical Center PA | |||||
| 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 | |||||
| 3/13/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $67,857 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Discussed with insured. | |||||||||||||||||||||
| Updates | |
| No updates found. |
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| Department File Number : | M201989063 |
| Claim Number : | FLO491 |
| Date Submitted : | 6/14/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HEALTHCARE UNDERWRITERS GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 74-3129288 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Maxine | A | Gutman | ||
| Street Address | |||||
| 1250 South Pine Island Road | |||||
| City | State | Zip | |||
| Plantation | FL | 33324 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 335 - 8231 | mgutman@hugroupinc.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mitchell | Samuels | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4651 Sheridan Street, Suite 270 | ||||
| City | State | Zip Code | County | ||
| Hollywood | FL | 33021 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 129-011 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Osteopathic Physician | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| OS5015 | Pediatrics - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Childrens Medical Center | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/28/2015 | 3/13/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Brain Tumor | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| alleged failure to diagnose | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No Misdiagnoses made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged failure to diagnose a brain tumor | |||||
| Severity Of Injury | |||||
| Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 7/20/2017 | CACE-17-013752 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Broward | 6/13/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| De Los Santos Florian, MD, Roosevelt Pediatric Associates Kalomiris, MD, Sophia | |||||
| 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 | |||||
| 6/13/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $100,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $79,547 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Discussed with insured | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. MITCHELL SAMUELS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MITCHELL SAMUELS, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).