Department File Number : | M202091327 |
Claim Number : | F15-0145-A-13 |
Date Submitted : | 2/3/2020 |
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 | Steven | R | Carey | ||
Street Address | |||||
4651 Salisbury Rd. Suite 410 | |||||
City | State | Zip | |||
Jacksonville | FL | 32256 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 309 - 8127 | (904) 309 - 8127 | scarey@norcal-group.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Potenciano | Gonzales | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 62 Spring Vista Drive, suite 101 | ||||
City | State | Zip Code | County | ||
Debary | FL | 32713 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MP10167 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME70587 | 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 | |||
F | Volusia | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
FISH MEMORIAL | 100072 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/13/2013 | 6/15/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to hospital with complaints of nausea, vomiting, abdominal cramps, and high blood sugar. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Physician ordered the administration of narcoticanalgesics. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleging the physician failed to appropriately administer narcotic analgesics. | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient allegedly suffered an anoxic brain injury. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/16/2015 | 2015-11825 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Volusia | 12/26/2019 | ||||
Other Defendants Involved in this Claim | |||||
Fish Memorial 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 | |||||
11/11/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $5,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $52,937 | ||||||||||||||||||||
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 the case have been discussed with the insured and Risk Management. |
Updates | |
No updates found. |
Does Dr. POTENCIANO GONZALES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. POTENCIANO GONZALES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).