Department File Number :	M200116982
Claim Number :	3510-A
Date Submitted :	7/27/2001

Insurer Information
Insurer Name				Coverage Type
PREFERRED PHYSICIANS MEDICAL RRG, INC.				Primary
Insurer FEIN		Professional License Number
36-3521189		UNKNOWN
Insurer Contact Information
Type		Entity Name
Entity		PREFERRED PHYSICIANS MEDICAL RRG, INC.
Street Address
7000 Squibb Road
City				State	Zip
Mission				KS	66202
Phone	Ext	Fax	E-Mail Address
(913) 262 - 2585		(923) 262 - 3633	cm1@ppmrrg.com

Insured Information
Type	First Name		MI	Last Name
Individual	JOHN			ACEVEDO, M.D.
Insurer Type		Street Address of Practice
Self-Insurer		2141 S. ALT. A1A, #430
City		State	Zip Code	County
JUPITER		FL	33477	Palm Beach
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
11268		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
0021586		Anesthesiology		Unk

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Injured Person Information
First Name	MI	Last Name		Date of Birth
Street Address			Gender	County where Injury Occurred
			M	*NR
City			State	Zip Code
Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
Name of Institution		Code
COLUMBIA POMPANO BEACH MEDICAL CENTER		100199
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
2/21/1994		12/6/1995

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition

Bowel perforation from motor vehicle accident

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Surgical repair of perforated bowel.

Diagnostic Code :

Misdiagnosis Made, If Any, Of Patient's Actual Condition

N/A

Principal Injury Giving Rise To The Claim

Death

Severity Of Injury

Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information
Date of Suit	Circuit Court Case Number
2/14/1996	96-01302 (05)
County Suit Filed in	Date of Final Disposition
Broward	7/21/1999
Other Defendants Involved in this Claim
ANESTHESIA ASSOCIATES OF POMPANO BEACH
Stage of Legal System at which Settlement was Reached or Award Made
After appeal.
Final Method of Claim Disposition
Disposed of by Court
Court Decision	Other
Summary judgment for the defendant.
Arbitration
Claim not subject to Arbitration.
Date of Payment

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

No

Indemnity Paid by Insurer on behalf of Insured

$0

Loss Adjust Expense Paid to Defense Counsel

$73,742

All Other Loss Adjustment Expense Paid

$0

Injured Person's Total Non-Economic Loss

$0

Deductible

$0

Injured Person's Total Economic Loss

	Incurred to Date	Anticipated
Medical Expense	$0	$0
Wage Loss	$0	$0
Other Expenses	$0	$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

None-lawsuit dismissed by summary judgment for Dr. Acevedo.

Updates

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