PLCR

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M2023104851
Claim Number : 41900010231
Date Submitted : 10/11/2023
 
Insurer Information
 
Insurer Name Coverage Type
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) Primary
Insurer FEIN Professional License Number
95-3014772  
Insurer Contact Information
Type First Name MI Last Name
Individual Kelly   Andrews
Street Address
12724 Gran Bay Parkway, W., Suite 400
City State Zip
Jacksonville FL 32258
Phone Ext Fax E-Mail Address
(904) 360 - 3038     kandrews@thedoctors.com
 
Insured Information
 
Type First Name MI Last Name
Individual DON R REVIS
Insurer Type Street Address of Practice
Licensed 4200 N Federal Highway
City State Zip Code County
Fort Lauderdale FL 33308 Broward
Policy Number Per Claim Policy Limits Aggregate Policy Limits
0059288 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME76322 Surgery - Plastic  

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
Other Outpatient Facility Surgical Suite
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
Special Procedure Room  
Date of Occurrence Date Reported to Insurer
2/23/2022 5/17/2022
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
The patient was a long term patient of our insured for cosmetic surgery.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Our insured member performed an assisted liposuction of the abdomen.
Diagnostic Code : 09
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
The patient ultimately died as a result of the liposuction due to a complication of perforations.
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 10/6/2023
Other Defendants Involved in this Claim
South Florida Plastic Surgery Associates
Physicians Outpatient Surgey Center
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
Other Settled
Arbitration
Claim not subject to Arbitration.
Date of Payment
10/6/2023
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $250,000
Loss Adjust Expense Paid to Defense Counsel $14,324
All Other Loss Adjustment Expense Paid $2,969
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
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate.
 
Updates
 
No updates found.

 

 

*NR: Prior to 04/28/1999 this field was not required in submitted claims.

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