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.