| Department File Number : | M201678806 |
| Claim Number : | 1031499-01 |
| Date Submitted : | 6/22/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL FIRE & MARINE INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 47-6021331 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Myra | J | Lassen | ||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Fort Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (800) 552 - 9906 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SANTIAGO | FIGUEREO BERLANGA | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 21097 BE 27th Court STE 540 | ||||
| City | State | Zip Code | County | ||
| Aventura | FL | 33180 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| ES011605 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME94748 | Neurology - Including Child - Minor Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| AVENTURA HOSPITAL AND MEDICAL CTR. | 100131 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 6/17/2015 | 1/21/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Lower back pain | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| L4-5 discecotomy with microdissection | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Failure to perform acceptable standard of care and treatment | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Neuro-deficits and disabilities | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 6/21/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Advanced Neuro Spine Institute, LLC Whitfield, Melvin D | |||||
| 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 | |||||
| 6/21/2016 | |||||
| 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 | $8,333 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $132,500 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| N/A | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 6/22/2016 3:56:40 PM | ||||||
| Reason for Change: | Update the injury severity | ||||||
| |||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. SANTIAGO FIGUEREO BERLANGA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SANTIAGO FIGUEREO BERLANGA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).