| Department File Number : | M201677045 |
| Claim Number : | 195098 |
| Date Submitted : | 6/2/2016 |
| 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 | dstokes@proassurance.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | TOMAS | CARRASQUILLO | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1206 Country Club Blvd | ||||
| City | State | Zip Code | County | ||
| Cape Coral | FL | 33990 | Lee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MP84403 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME36576 | Surgery - Vascular | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Hospital Inpatient Facility | |||||
| Name of Institution | Code | ||||
| LEE MEMORIAL HOSPITAL-HEALTHPARK | 120005 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Operating Suite | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/20/2014 | 5/15/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Supraumbilical Ventral Hernia | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Attempted Hernia Repair, Excision of Soft Tissue Mass Subumbilical Abdomen | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No Misdiagnosis was made | |||||
| Principal Injury Giving Rise To The Claim | |||||
| 74 YOM underwent surgery for supraumbilical ventral hernia and mass was excised from subumbilical abdomen | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 2/5/2016 | ||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 2/5/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $10,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $967 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $2 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $10,000 | ||||||||||||||||||||
| 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: | 5/16/2016 12:49:20 PM | |||||||||
| Reason for Change: | Updated non economic loss information and legal fees paid. | |||||||||
| ||||||||||
| Date of Change: | 6/2/2016 2:46:13 PM | |||||||||
| Reason for Change: | updated ALAE amounts | |||||||||
| ||||||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. TOMAS CARRASQUILLO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. TOMAS CARRASQUILLO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).