Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
*NR:Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Department File Number : | M201886098 |
| Claim Number : | 2017FL260 |
| Date Submitted : | 8/8/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PHYSICIANS CASUALTY RISK RETENTION GROUP, INC. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 27-3867083 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jody | Schwahn | |||
| Street Address | |||||
| 611 Druid Road E, Suite 512 | |||||
| City | State | Zip | |||
| Clearwater | FL | 33756 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (727) 581 - 6400 | 6400 | jschwahn@physicianscasualty.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | ROLANDO | GOMEZ | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 304 S. Harbor City Boulevard, Suite 101 | ||||
| City | State | Zip Code | County | ||
| Melbourne | FL | 32901 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PC-2017-1092 | $25,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME71207 | Surgery - Obstetrics - Gynecology | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Brevard | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Outpatient Facility | |||||
| Name of Institution | Code | ||||
| HOLMES REGIONAL MEDICAL CENTER | 100019 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/16/2016 | 9/25/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Hysterectomy as a preventative measure due to estrogen positive breast cancer resulting in higher chances of uterine cancer. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Hysterectomy | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Transected ureters and perforated bladder. | |||||
| Severity Of Injury | |||||
| Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 7/30/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Holmes Reginal Medical Center Medical Associates of Brevard LLC | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 7/30/2018 | |||||
| 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 | $15,425 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $2,122 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| No | |||||||||||||||||||||
| 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. ROLANDO R GOMEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ROLANDO R GOMEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).