Department File Number : | M201574357 |
Claim Number : | 201507089 |
Date Submitted : | 4/22/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
ASHOURI, MODAR | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-1507087 | ME47827 | ||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MOIDAR | ASHOURI | |||
Street Address | |||||
6615 SW. 83 AVE | |||||
City | State | Zip | |||
MIAMI | FL | 33143 | |||
Phone | Ext | Fax | E-Mail Address | ||
(786) 942 - 9600 | moidarmiami@gmail.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | MODAR | ASHOURI | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 6615 SW 83 AVE | ||||
City | State | Zip Code | County | ||
MIAMI | FL | 33143 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PLM-200794-0314 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME47827 | Radiology - Diagnostic - 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 | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
COLUMBIA KENDALL MEDICAL CENTER | 100209 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Labor and Delivery Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
10/16/2013 | 5/20/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
MACROSOMIAThe information here are limited due to space limitation but the patient's mother had complete prenatal workup at an outside facility indicating the presence of Macrosomia and those information were not available when the ultrasound was performed. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
VAGINAL DELIVERY | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
The sonographer had performed an ultrasound to estimate the fetal age and weight and had estimated the fetal weight to be equal to 3462 grams plus or minus 249 grams and I had reported the ultrasound as per the sonographer measurments. | |||||
Principal Injury Giving Rise To The Claim | |||||
Vaginal delivery was performed which was complicated by a shoulder injury( Dystocia)and a right brachial plexus injury as the actual baby's weight on delivery was 4500 grams indicating incorrect measurments by the sonographer which were included in my report | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/10/2014 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim subject to arbitration, but settlement reached in lieu of award. | |||||
Date of Payment | |||||
12/10/2014 |
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $250,000 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Making the medical records from outside facility available at delivery and the deliverying doctor should be aware of the prenatal medical findings.Emphasizing that the sonographer do his measurments and numbers correctly. |
Updates | |||||||||||||
Date of Change: | 4/22/2015 1:58:39 PM | ||||||||||||
Reason for Change: | adding more clinical information | ||||||||||||
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*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Department File Number : | M201472254 |
Claim Number : | 10317 |
Date Submitted : | 10/8/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FD INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-3704679 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Linda | D | Collins | ||
Street Address | |||||
4651 Salisbury Road, Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 296 - 2887 | 214 | (904) 296 - 1245 | lcollins@fldic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Modar | Ashouri | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7361 SW 120th Avenue | ||||
City | State | Zip Code | County | ||
Miami | FL | 33183 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
11970 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME47827 | Radiology - Diagnostic - 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 | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
KENDALL ENDOSCOPY AND SURGERY CENTER | 14960457 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/2/2007 | 4/16/2009 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to the ER with complaint of headache. CT scan was performed with this insured reading the scan. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
CT scan read. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None made. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to properly interpret CT of the brain. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
3/29/2010 | 10-18395 CA 31 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 9/10/2014 | ||||
Other Defendants Involved in this Claim | |||||
Kendall Healthcare Group, LTD d/b/a Kendall Regional Medical Kendall Regional Radiology & Imaging Associates, Inc. Sheridan Emergency Physician Services, Inc. Agostini-Miranda, M.D., Alex Taladriz, M.D., Arturo | |||||
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 | |||||
9/10/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $200,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $46,128 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Circumstances of this case have been discussed with the insured and Risk Management was notified. |
Updates | |
No updates found. |
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Does Dr. MODAR ASHOURI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MODAR ASHOURI, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).