Department File Number : | M201574640 |
Claim Number : | 50241/50242 |
Date Submitted : | 6/11/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 370 - 3813 | (407) 370 - 2247 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ralph | F | Gonzalez | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 3930 8th Ave. W. | ||||
City | State | Zip Code | County | ||
Bradenton | FL | 34205 | Manatee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1600154 16 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME73150 | Neurology - Including Child - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Manatee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
LAKEWOOD RANCH MEDICAL CENTER | 23960046 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/19/2012 | 7/25/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Stenotic basil artery | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged delay in diagnosis and treatment of stenotic basil artery | |||||
Principal Injury Giving Rise To The Claim | |||||
Cerebellar infarct | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/27/2015 | 2015-50-CA-000438-AX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Manatee | 6/5/2015 | ||||
Other Defendants Involved in this Claim | |||||
Martinez, MD, Hector A Paragon Emergency Services, Inc. Thomas, MD, John L John, MD, Bijoy K Cape Coral Hospitalists, Inc. Bradenton Neurology, Inc. Wasserman, DO, Jeffrey D Bilodeau, MD, Richard G Manatee Lakewood Radiology Assoc. Lakewood Ranch Medical Center Wellington Regional Medical Center Universal Health Services | |||||
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 | |||||
4/17/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $500,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $11,290 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11,680 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |||||||
Date of Change: | 6/11/2015 3:26:53 PM | ||||||
Reason for Change: | Report updated to reflect Court Document final disposition date of 06/05/15 | ||||||
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Department File Number : | M201883995 |
Claim Number : | 50979 |
Date Submitted : | 1/5/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MAG MUTUAL INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1449198 | |||||
Insurer Contact Information | |||||
Type | Entity Name | ||||
Entity | MAG MUTUAL INSURANCE COMPANY | ||||
Street Address | |||||
8427 South Park Circle Suite 130 | |||||
City | State | Zip | |||
Orlando | FL | 32819 | |||
Phone | Ext | Fax | E-Mail Address | ||
(407) 470 - 3813 | (404) 842 - 3319 | ctschanz@magmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ralph | F | Gonzalez | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 200 3rd Ave. W. Ste. 110 | ||||
City | State | Zip Code | County | ||
Bradenton | FL | 34205 | Manatee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PSL 1600154 16 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME73150 | Neurology - Including Child - Minor Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Manatee | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
MANATEE MEMORIAL HOSPITAL | 100035 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Radiology, Emergency Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/5/2013 | 9/16/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Stroke | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No iatrogenic injury | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to timely diagnose and treat evolving stroke | |||||
Principal Injury Giving Rise To The Claim | |||||
Permanent neurological damage | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/20/2015 | 41-2015-CA-000361AX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Manatee | 12/12/2017 | ||||
Other Defendants Involved in this Claim | |||||
Scott, MD, Shekyla N Manatee Memorial Hospital Paragon Emergency Services Bradenton Neurology | |||||
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 | |||||
12/12/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $99,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $88,626 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $113,275 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Risk management has counseled insured |
Updates | |
No updates found. |
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Does Dr. RALPH F GONZALEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RALPH F GONZALEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).