| Department File Number : | M201988615 |
| Claim Number : | TH-17-LLA-383584 |
| Date Submitted : | 4/29/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| TEAM HEALTH, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 62-1562558 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kathy | A | Stockton | ||
| Street Address | |||||
| 1900 W. LOOP S., STE. 1500 | |||||
| City | State | Zip | |||
| Houston | TX | 77027 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (713) 935 - 2404 | (713) 461 - 8130 | kathy_stockton@westernlitigation.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | RAFAEL | SANTIAGO-APONTE | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 200 AVENUE F NE, WINTER HAVEN HOSPITAL | ||||
| City | State | Zip Code | County | ||
| WINTER HAVEN | FL | 33881 | Polk | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| ES1800 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME114771 | Emergency Medicine - Including Major Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Polk | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Emergency Room | |||||
| Name of Institution | Code | ||||
| WINTER HAVEN HOSPITAL | 100052 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | ER | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/22/2016 | 12/18/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| PE | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| SEEN IN ER | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| ALLEGED FAILURE TO DIAGNOSE AND TREAT | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DEATH DUE TO PE | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/15/2018 | 2018-CA-00202000000 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Polk | 4/29/2019 | ||||
| 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 | |||||
| Award for plaintiff. | |||||
| Date of Payment | |||||
| 4/2/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $38,258 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $10,259 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| UNKNOWN | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. RAFAEL SANTIAGO-APONTE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RAFAEL SANTIAGO-APONTE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).