Department File Number :

M200327389

Claim Number :

0572MA2037-09J014

Date Submitted :

11/21/2003

 

Insurer Information

 

Insurer Name

Coverage Type

ST. PAUL FIRE & MARINE INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

41-0406690

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

PAT

 

KANE

Street Address

3230 W. Commercial Blvd., Suite 390

City

State

Zip

Ft. Lauderdale

FL

33309

Phone

Ext

Fax

E-Mail Address

(954) 677 - 3324

 

(954) 735 - 9028

 

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

EULOGIA

 

VIZCARRA, MD

Insurer Type

Street Address of Practice

Licensed

721 S. JEFFERSON STREET

City

State

Zip Code

County

PERRY

FL

32347

Taylor

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

0572MA2037

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME30012

Internal Medicine - Minor Surgery

01

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

Prison

Infirmary-Calhoun Correctional

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

10/19/1998

5/25/2000

 

Diagnostic Information

 

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

Injured hernia

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Plaintiff alleged he re-injured his hernia because he was not assigned to lighter duty

Diagnostic Code :

 

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

None

Principal Injury Giving Rise To The Claim

Hernia

Severity Of Injury

Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

5/24/2000

4-00 CV98 WS

County Suit Filed in

Date of Final Disposition

Leon

7/14/2003

Other Defendants Involved in this Claim

 

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

Directed verdict for 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

$16,450

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

 

Updates

 

No updates found.