| Department File Number : | M202092367 |
| Claim Number : | HPT 1497 |
| Date Submitted : | 4/30/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| Zacharis, Theodossis | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 20-0604706 | ME95732 | ||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Carol | Wiseheart | |||
| Street Address | |||||
| 747 S Ridgewood Ave | |||||
| City | State | Zip | |||
| Daytona Beach | FL | 32114 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (386) 310 - 7969 | (386) 310 - 7973 | cwiseheart@halifaxins.org | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Theodossis | Zacharis | |||
| Insurer Type | Street Address of Practice | ||||
| Self-Insurer | 1055 N Dixie Freeway, Suite 1 | ||||
| City | State | Zip Code | County | ||
| New Smyrna Beach | FL | 32168 | Volusia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 02-110 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME95732 | Internal Medicine - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Volusia | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| 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 | ||||
| 3/16/2016 | 3/16/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Sepsis, Pneumonia & Respiratory Failure | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Critical care provided. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Cardiac secondary to respiratory issues. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 8/7/2018 | 2018 11336 CIDL | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Volusia | 3/31/2020 | ||||
| Other Defendants Involved in this Claim | |||||
| Ailani, M.D., Rajesh Select Specialty Hospital-Daytona Beach, Inc. Hassan, M.D., Syed A Venzon, M.D., Roy P Inpatient Consultants of Florida, Inc. Memorial Hospital-West Volusia, Inc. d/b/a Florida Hospital- Lewis & Klancke Cariology, P.A. d/b/a Daytona Heart Group PCCC of Volusia, LLC Ghade, M.D., Girish V Girish Ghade, LLC Nagarajan, M.D., Ravi Akshaya Balaji, LLC | |||||
| 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 | |||||
| 3/20/2020 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $225,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $61,396 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| On going risk management | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. THEODOSSIS ZACHARIS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. THEODOSSIS ZACHARIS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).