PLCR

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M2023104076
Claim Number : 176253-3
Date Submitted : 7/23/2024
 
Insurer Information
 
Insurer Name Coverage Type
HEALTH CARE INDEMNITY, INC. Primary
Insurer FEIN Professional License Number
61-0904881  
Insurer Contact Information
Type First Name MI Last Name
Individual Christina J Stoker
Street Address
2515 PARK PLAZA, BLDG 2-3E
City State Zip
Nashville TN 37203
Phone Ext Fax E-Mail Address
(615) 344 - 1779   (866) 715 - 7235 christina.stoker@hcahealthcare.com
 
Insured Information
 
Type First Name MI Last Name
Individual FERNANDO E BAYRON-VELEZ
Insurer Type Street Address of Practice
Licensed 7201 N UNIVERSITY DR
City State Zip Code County
TAMARAC FL 33321 Broward
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HCI-10122 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME93401 Surgery - General  

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 Broward
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Inpatient Facility  
Name of Institution Code
UNIVERSITY HOSPITAL AND MEDICAL CTR.(TAMARAC) 100224
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
4/26/2022 3/10/2023
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
HISTORY OF COLON CANCER ADMIT FOR ELECTIVE ROBOTIC COLON MASS RESECTION.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
PROCEDURE CONVERTED TO OPEN DUE TO HYPOTENSION, INTRAOPERATIVE BLEEDING SECONDARY TO TROCAR INJURY.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
DEVELOPED SEPSIS, MULTI-ORGAN FAILURE AND DEATH.
Severity Of Injury
Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Legal Information
 
Date of Suit Circuit Court Case Number
  *NR
County Suit Filed in Date of Final Disposition
*NR 8/15/2023
Other Defendants Involved in this Claim
 
Stage of Legal System at which Settlement was Reached or Award Made
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed).
Final Method of Claim Disposition
Settled by parties
Court Decision Other
No Court Proceedings.  
Arbitration
Claim not subject to Arbitration.
Date of Payment
8/7/2023
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $99,000
Loss Adjust Expense Paid to Defense Counsel $10,347
All Other Loss Adjustment Expense Paid $7,705
Injured Person's Total Non-Economic Loss $45,000
Deductible $0
Injured Person's Total Economic Loss
  Incurred to Date Anticipated
Medical Expense $18,000 $0
Wage Loss $0 $36,000
Other Expenses $0 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
REFERRED TO RISK MANAGEMENT
 
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.