| Department File Number : | M201885452 |
| Claim Number : | 327655 |
| Date Submitted : | 6/5/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-3014772 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kelly | Andrews | |||
| Street Address | |||||
| 12724 Gran Bay Parkway, W., Suite 400 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Omar | l | Blanco | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2750 SW 37th Avenue | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33134 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0954320 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Physician Assistant | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| PA9000004 | Physicians or Surgeons Assistants | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Hospital/Institution | Kendall Regional Medical Center | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Radiology, Emergency Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 2/5/2013 | 3/3/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Dislocated distal radial fracture. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The patient alleged failure to perform an emergent surgical release of the median nerve and repair. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The patient alleged permanent nerve damage to his median nerve. | |||||
| 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 | ||||
| 3/2/2015 | 2015-2992-CA-01 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 5/7/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Khouri, Roger Palmetto General Hospital | |||||
| 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 | |||||
| 5/7/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $42,254 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $12,645 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $150,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| 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 : | M201884524 |
| Claim Number : | 027-094188 |
| Date Submitted : | 3/7/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| LEXINGTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-1149494 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | carolyn | r | ewell | ||
| Street Address | |||||
| 17200 W 119th St | |||||
| City | State | Zip | |||
| Olathe | KS | 66061 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (913) 495 - 4217 | carolynranee.ewell@aig.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Omar | L | Blanco | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2750 SW 37th Ave | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33133 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 1393765 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Physician Assistant | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| PA9000004 | Physicians or Surgeons Assistants | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| MIAMI HAND CENTER, LLC | 14960354 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/24/2008 | 12/3/2008 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| 42 y/o male patient alleges left fingers burned by treatment in hot water | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Plaintiff suffered a crushed tip of the left middle and ring fingers with a sharp edge of a bean while at work. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Burning that occurred when plaintiff's hand was placed under water. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| 42 y/o male patient alleges left fingers burned by treatment in hot water. | |||||
| 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 | ||||
| 3/23/2015 | 10-38962 CA23 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 3/7/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| 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 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $7,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $26,663 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $30,537 | ||||||||||||||||||||
| 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. |
This page is not displaying certain sensitive information.
Does Dr. OMAR L BLANCO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. OMAR L BLANCO, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).