Department File Number : | M201885917 |
Claim Number : | 02222018466 |
Date Submitted : | 7/13/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Univ of FL JHMHC Self-Insurance Program | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-600205 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kristin | Belyew | |||
Street Address | |||||
PO BOX 112735 | |||||
City | State | Zip | |||
Gainesville | FL | 32611 | |||
Phone | Ext | Fax | E-Mail Address | ||
(352) 273 - 7232 | (352) 273 - 5424 | belyewK@ufl.edu |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Nicole | Provost | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1600 SW Archer Road | ||||
City | State | Zip Code | County | ||
Gainesville | FL | 32610 | Alachua | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
UFBOT16G | $300,000 | *NR | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME65302 | Surgery - General |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Alachua | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
SHANDS HOSPITAL | 100113 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/17/2016 | 2/21/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Carcinoma of cervix | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Missed diagnosis | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Post-menopausal bleeding | |||||
Principal Injury Giving Rise To The Claim | |||||
Progression of cancer | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 5/4/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
5/4/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $300,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,349 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Assessment of treatment with physician |
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. NICOLE PROVOST, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. NICOLE PROVOST, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).