Department File Number :

M200430034

Claim Number :

83-007823

Date Submitted :

3/30/2004

 

Insurer Information

 

Insurer Name

Coverage Type

TRUCK INSURANCE EXCHANGE

Primary

Insurer FEIN

Professional License Number

95-2575892

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

JULIE

L

BICKNELL

Street Address

P.O. BOX 4999

City

State

Zip

LOS ANGELES

CA

90051-4999

Phone

Ext

Fax

E-Mail Address

(323) 964 - 8271

 

(323) 937 - 1919

 

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

ROSSANA

 

LOPEZ, M.D.

Insurer Type

Street Address of Practice

Licensed

777 E. 25TH ST., #516

City

State

Zip Code

County

HIALEAH

FL

33013

Dade

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

0118082130000

$250,000

$750,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME-0064156

 

N/A

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

Patient's Home

 

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

8/11/2000

2/15/2002

 

Diagnostic Information

 

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

Male patient developed skin breakdown on his sacrum & heels, which he alleges were as a result of the insured's negligence.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Insured's staff failed to properly monitor and determine the true condition of the patient.

Diagnostic Code :

 

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

N/A

Principal Injury Giving Rise To The Claim

Skin breakdown, which resulted in scarring.

Severity Of Injury

Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

10/22/2002

02-4549 CA09

County Suit Filed in

Date of Final Disposition

Dade

3/5/2004

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

 

 

Financial Information

 

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$25,000

Loss Adjust Expense Paid to Defense Counsel

$6,019

All Other Loss Adjustment Expense Paid

$0

Injured Person's Total Non-Economic Loss

$25,000

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

Being more careful in monitoring the patient's for possible skin breakdown.

 

Updates

 

No updates found.