| Department File Number : | M201886160 |
| Claim Number : | 166717 |
| Date Submitted : | 8/15/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NORCAL MUTUAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 94-2301054 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Diane | McNab | |||
| Street Address | |||||
| 4651 Salisbury Road | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (954) 439 - 0580 | dmcnab@norcal-group.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Victoriano | C | Gutierrez | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1700 Baker Ave East | ||||
| City | State | Zip Code | County | ||
| Haines City | FL | 33844 | Polk | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 724379N | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| ME59211 | Family Physicians or General Practitioners - No Surgery | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Polk | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Patient's Home | |||||
| Name of Institution | Code | ||||
| C-MED AMBULATORY SURGERY CENTER | 14960345 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | physician office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/5/2017 | 10/31/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient had a history of COPD. The patient presented with complaints of cough and shortness of breath. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Based upon this practitioner's physical exam, the working diagnosis was COPD, smoker & pleurisy. The Estate alleged there was a failure to timely diagnose and treat a bilateral pulmonary embolism. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| The patient was diagnosed with COPD, smoker and pleurisy, however, a CTA of the chest reflected a bilateral pulmonary embolism. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Death. | |||||
| Severity Of Injury | |||||
| Permanent: Death. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 8/3/2018 | ||||
| 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 | |||||
| Dropped before Action Filed | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 7/30/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $175,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $6,700 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $6,700 | ||||||||||||||||||||
| 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 met with defense counsel and claims specialist. | |||||||||||||||||||||
| 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. VICTORIANO C GUTIERREZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. VICTORIANO C GUTIERREZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).