Department File Number : | M201574370 |
Claim Number : | 5384799969US |
Date Submitted : | 4/22/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-0687550 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Rosalind | Manning | |||
Street Address | |||||
17200 West 119th | |||||
City | State | Zip | |||
Olathe | KS | 66061 | |||
Phone | Ext | Fax | E-Mail Address | ||
(913) 495 - 3384 | rosalind.manning@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Raymond | Fernandez | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1619 6th street ,SE | ||||
City | State | Zip Code | County | ||
Winter Haven | FL | 33880 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
018586671 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Chiropractic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
CH6385 | Physicians - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Outpatient Facility | |||||
Name of Institution | Code | ||||
WINTER HAVEN HOSPITAL | 100052 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/13/2012 | 5/1/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
FAILURE TO DIAGNOSE SPINAL MASSRESULTING IN A TERMINAL DIAGNOSIS. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Plaintiff alleges that the defendants failed to diagnose his cancer timely. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Plaintiff alleges that the defendants failed to diagnose his cancer timely. | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff alleges that the defendants failed to diagnose his cancer timely. | |||||
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 | ||||
4/13/2012 | 2014-CA-002912 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 4/21/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within 90 days of suit being filed. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
Directed verdict for plaintiff. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/22/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $12,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $13,296 | ||||||||||||||||||||
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 | |||||||||||||||||||||
make perfect diagnose |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201678463 |
Claim Number : | 501-034151 |
Date Submitted : | 5/18/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-0687550 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Darra | Thomas-Davis | |||
Street Address | |||||
17200 W 119th st | |||||
City | State | Zip | |||
Olathe | KS | 66061 | |||
Phone | Ext | Fax | E-Mail Address | ||
(913) 495 - 6569 | darra.thomasdavis@aig.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | RAYMOND | FERNANDEZ | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1619 6th St SE | ||||
City | State | Zip Code | County | ||
Winter Haven | FL | 33880 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
018586672 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Chiropractic Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
CH6385 | Physicians - No Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Alachua | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
WINTER HAVEN HOSPITAL | 100052 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/13/2012 | 5/1/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
39 year old male alleged failure to diagnose spinal mass resulting in a terminal diagnosis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
39 year old male alleged failure to diagnose spinal mass resulting in a terminal diagnosis. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
39 year old male alleged failure to diagnose spinal mass resulting in a terminal diagnosis. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/13/2012 | 2014-CA-002912 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 4/21/2015 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within 90 days of suit being filed. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
Directed verdict for plaintiff. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/22/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $12,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $26,072 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,914 | ||||||||||||||||||||
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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. RAYMOND FERNANDEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. RAYMOND FERNANDEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).