Department File Number : | M201576359 |
Claim Number : | FL0408 |
Date Submitted : | 11/19/2015 |
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 | PLACIDO | ROQUIZ | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 6801 US 27 North, Suite B-1 | ||||
City | State | Zip Code | County | ||
Sebring | FL | 33870 | Highlands | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
233-000 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME48281 | Physicians - Minor Surgery. NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Highlands | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Physicians Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/29/2011 | 3/6/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Alleged failure to appreciate areas of concern for colon cancer and biopsy | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No injury caused by operation diagnostic or treatment rendered | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to appreciate areas of concern for colon cancer and biopsy/remove which resulted in metastatic adenocarcinoma from colorectal origin | |||||
Severity Of Injury | |||||
Emotional Only - Fright, no physical damage |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 11/16/2015 | ||||
Other Defendants Involved in this Claim | |||||
Placido Roquiz Jr. MD PA Surgical Center at Sun N Lake LLC | |||||
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 | ||||
No Court Proceedings. | |||||
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 | $13,649 | ||||||||||||||||||||
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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. PLACIDO ROQUIZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. PLACIDO ROQUIZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).