Department File Number : | M201990077 |
Claim Number : | 25676-01 |
Date Submitted : | 9/26/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
PROASSURANCE INSURANCE COMPANY OF AMERICA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
58-1403235 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Angeline | Schave | |||
Street Address | |||||
3000 Meridian Blvd. Ste. 400 | |||||
City | State | Zip | |||
Franklin | TN | 37067 | |||
Phone | Ext | Fax | E-Mail Address | ||
(615) 371 - 8776 | 2998 | (615) 986 - 1945 | aschave@picagroup.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ryan | Pereira | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 1301 Plantation Island Drive, Ste. 203 | ||||
City | State | Zip Code | County | ||
Saint Augustine | FL | 32080 | St. Johns | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
1PD0014111 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Podiatric Physician | |||||
License Number | Specialty Code & Classification | Certification Number | |||
PO3002 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | St. Johns | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/8/2016 | 8/21/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Vericose veins, both legs; Lump on right leg | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Endovenous radiofrequency ablation; ultrasound lower limb | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient presented to the insured with sore and painful varicose veins on both legs. During this initial visit, insured noted a lump on the lateral side of the patient's right leg near the ankle. Over the next several visits, the patient reported the symptoms were worse and the initial mass was larger and an additional mass had been discovered on his right groin. Insured instructed the patient to continue using the ankle brace, compression stockings and heating pad to help with discomfort and to follow up with his primary care physician regarding the mass on his groin. The patient's leg began to show improvement through the last visit with the insured on 3/8/16. Patient went on to treat with another doctor who diagnosed the patient with a high grade sarcoma with extensive necrosis. Patient alleges insured failed to appropriately evaluate or diagnose; Refer patient for a diagnostic work-up and intervention resulting in a delay in diagnosis. | |||||
Severity Of Injury | |||||
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 9/12/2019 | ||||
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 | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $450,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $138,055 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,187 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Specialty Code 80993 |
Updates | |
No updates found. |
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