Department File Number : | M201575447 |
Claim Number : | 95631 |
Date Submitted : | 8/5/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICUS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
20-5623491 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Dionysia | Lawson | |||
Street Address | |||||
560 Davis Street | |||||
City | State | Zip | |||
San Francisco | CA | 94111 | |||
Phone | Ext | Fax | E-Mail Address | ||
(415) 735 - 2013 | (415) 735 - 2097 | dlawson@norcalmutual.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Xenia | Ventura | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 15250 NW 14th Drive | ||||
City | State | Zip Code | County | ||
Alachua | FL | 32615 | Alachua | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL-16024849 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Other | Hospitalists | ||||
License Number | Specialty Code & Classification | Certification Number | |||
ME109644 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Alachua | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Hospital Inpatient Facility | |||||
Name of Institution | Code | ||||
NORTH FLORIDA REGIONAL MEDICAL CENTER | 100204 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
3/21/2012 | 5/27/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
seizures and viral infection | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
improper dosage of Acyclovir | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
This then 82-year-old male alleges improper dosage of Acyclovir resulting in kidney failure and severe encephalopathy. | |||||
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 | ||||
8/29/2014 | 01-2014-CA-002762 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Alachua | 6/16/2015 | ||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
6/23/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $50,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $35,142 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $10,203 | ||||||||||||||||||||
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 Claims Specialist and defense attorney concerning claim. |
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. XENIA VENTURA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. XENIA VENTURA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).