Department File Number : | M201885709 |
Claim Number : | EMC-FL-16-356834 |
Date Submitted : | 6/21/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
EmCare Holdings, Inc. | Primary | ||||
Insurer FEIN | Professional License Number | ||||
75-173235 | SI | ||||
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 | SAMEER | P | DRAVIAM | ||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 10000 W COLONIAL DR | ||||
City | State | Zip Code | County | ||
OCOEE | FL | 34761 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HAZ1040025381-14 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME116541 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Osceola | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Emergency Room | |||||
Name of Institution | Code | ||||
OSCEOLA REGIONAL HOSPITAL | 100110 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | ER | ||||
Date of Occurrence | Date Reported to Insurer | ||||
8/2/2014 | 1/12/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
LACERATION | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
SEEN IN ER | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
FAILURE TO TREAT | |||||
Principal Injury Giving Rise To The Claim | |||||
DELAYED SURGICAL REPAIR | |||||
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 | 5/10/2018 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
No Payment Made | |||||
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? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $9,045 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,468 | ||||||||||||||||||||
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. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. SAMEER P DRAVIAM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SAMEER P DRAVIAM, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).