| Department File Number : | M201885353 |
| Claim Number : | 217925 |
| Date Submitted : | 7/10/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| PROASSURANCE CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 38-2317569 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Denise | Stokes | |||
| Street Address | |||||
| 100 Brookwood Place | |||||
| City | State | Zip | |||
| Birmingham | AL | 35209 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (205) 802 - 4790 | (205) 802 - 4710 | claimscompliancereporting@proassurance.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SIU-MEI | M | CHAN | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4960 SW 72nd Avenue, Suite 400 | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33155 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| ES1855 | $1,000,000 | $5,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME100289 | Surgery - General | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Monroe | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Prison | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Correctional Facility | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/28/2015 | 1/27/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient alleged failure to treat head and eye wounds after falling out of bed which lead to a concussion traumatic brain injury and loss of vision. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Failure to treat. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Concussion, TBI and loss of vision. | |||||
| 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 | ||||
| 1/27/2017 | 16-10080-CIV-MOORE | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Monroe | 3/26/2018 | ||||
| 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 | |||||
| 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 | $13,210 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $4,189 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured discussed case with defense counsel, insurance personnel, and medical experts. | |||||||||||||||||||||
| Updates | |||||||
| Date of Change: | 7/10/2018 1:47:13 PM | ||||||
| Reason for Change: | updated alae | ||||||
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Does Dr. SIU-MEI M CHAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SIU-MEI M CHAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).