Department File Number : | M201680416 |
Claim Number : | wc/101908-14 |
Date Submitted : | 11/21/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
Watson Clinic LLP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-070493 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Diane | Szymanski | |||
Street Address | |||||
1600 Lakeland Hills Blvd | |||||
City | State | Zip | |||
Lakeland | FL | 33805 | |||
Phone | Ext | Fax | E-Mail Address | ||
(863) 680 - 7620 | (863) 616 - 2430 | aszymanski@watsonclinic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | VITO | LAZO DE LA VEGA | |||
Insurer Type | Street Address of Practice | ||||
Self-Insurer | 1600 Lakeland Hills Blvd | ||||
City | State | Zip Code | County | ||
Lakeland | FL | 33805 | Polk | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
PH1404269-PL | $2,000,000 | $18,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME101761 | Emergency Medicine - No Major Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Polk | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
Lakeland Regional Medical Center | 100157 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
12/8/2012 | 12/15/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Pericardial Effusion | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Not applicable, the Patient's condition was not caused by an operation, diagnostic treatment or procedure. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis was made in this case. Aortic dissection was not recognized during CT interpretation. | |||||
Principal Injury Giving Rise To The Claim | |||||
51 year old presents to ER with complaints of chest pain. Attending ER physician diagnosed condition as pericardial effusion and transferred care to on-call hospitalist. Approx. 21 hours after presenting to hospital, Patient unexpectedly expired. Cause of death - massive hemopericardium and cardiac tamponade from an aortic dissection | |||||
Severity Of Injury | |||||
Permanent: Death. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/24/2015 | 2015CA-001483 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Polk | 10/28/2016 | ||||
Other Defendants Involved in this Claim | |||||
Radiology & Imaging Specialists of Lakeland Pyles RN, Angelia P Roddenberry RN, Sandra Rodgers MD, Christopher Javed MD, Khurram Lakeland Regional Medical Center EMCare Holdings | |||||
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 | |||||
10/28/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $99,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $47,074 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $9,358 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Circumstance of event reviewed with individual parties involved. |
Updates | |
No updates found. |
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Does Dr. VITO LAZO DE LA VEGA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. VITO LAZO DE LA VEGA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).