Department File Number : | M201573428 |
Claim Number : | 1015692-01 |
Date Submitted : | 2/11/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Susan | K | Spielman | ||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Nelson | Pereira | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1301 Lyons Road | ||||
City | State | Zip Code | County | ||
Coconut Creek | FL | 33063 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
724553 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44944 | 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 | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NORTHWEST MEDICAL CENTER | 100189 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/9/2012 | 9/1/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Progressive leg weakness | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Steroids/frequent transfusions | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Negligent failure to appropriately andtimely treat | |||||
Principal Injury Giving Rise To The Claim | |||||
Death | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 1/27/2015 | ||||
Other Defendants Involved in this Claim | |||||
MCCI Holdings LLC | |||||
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 | |||||
Dropped before Action Filed | |||||
Court Decision | Other | ||||
Other | Not Pursued | ||||
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 | $2,500 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,491 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
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.
Department File Number : | M201680555 |
Claim Number : | 1015712 |
Date Submitted : | 8/17/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Nelson | Pereira | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1301 Lyons Rd | ||||
City | State | Zip Code | County | ||
Coconut Creek | FL | 33063 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
724553 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME44944 | Family Physicians or General Practitioners - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NORTHWEST MEDICAL CENTER | 100189 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
1/27/2013 | 9/24/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Chest pain and shortness of breath | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Diagnostic stent, Plavix, Aspirin | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Failure to discontinue Plavix & aspirin with known hemorrhagic, pericardial effusion | |||||
Principal Injury Giving Rise To The Claim | |||||
Brain damage, kidney and liver damage | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/18/2014 | CACE 14 003277 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Broward | 11/21/2016 | ||||
Other Defendants Involved in this Claim | |||||
Northwest Medical CenterInc Aguilar MD, Nelson E Maytin & Uria MD PA Bhagchandani MD, Lal K Lal Bhagchandani MD PA MCCI Group Holdings LLC Maytin MD, Orlando | |||||
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 | ||||
Other | Dismissed-no payment | ||||
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 | $24,571 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11,902 | ||||||||||||||||||||
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 | |||||||||||||||||||||
n/a |
Updates | ||||||||||
Date of Change: | 2/20/2017 1:40:07 PM | |||||||||
Reason for Change: | ALE UPDATE 2/20/2017 | |||||||||
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Date of Change: | 8/17/2017 1:35:09 PM | |||||||||
Reason for Change: | ALE UPDATE 8/17/2017 | |||||||||
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Does Dr. NELSON PEREIRA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. NELSON PEREIRA, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).