PLCR

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M200641975
Claim Number : A06-33540-04
Date Submitted : 8/16/2006
 
Insurer Information
 
Insurer Name Coverage Type
VERDE INSURANCE COMPANY Primary
Insurer FEIN Professional License Number
59-6614702  
Insurer Contact Information
Type First Name MI Last Name
Individual Cheri M Montague
Street Address
1000 Riverside Avenue, Suite 800
City State Zip
Jacksonville FL 32204
Phone Ext Fax E-Mail Address
(800) 741 - 3742 3043 (904) 358 - 6728 montague@fpic.com
 
Insured Information
 
Type First Name MI Last Name
Individual Neelam T Uppal
Insurer Type Street Address of Practice
Licensed 5840 Park Blvd.
City State Zip Code County
Pinellas Park FL 33781 Pinellas
Policy Number Per Claim Policy Limits Aggregate Policy Limits
50104 $250,000 $750,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME59800 Infectious Diseases - No Surgery 80246

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
  F Pinellas
City State Zip Code
     
Location where injury occured Other location where injury occured
Physician's Office  
Name of Institution Code
   
Location of Institutional Injury Other Location of Institutional Injury
   
Date of Occurrence Date Reported to Insurer
12/1/2004 1/4/2006
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Mycoplasma, immune deficiency, MRSA infection.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
IV administration of vitamins and gamma globulin and IV antibiotics.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Patient had scar on chest from MRSA infected IV port.
Severity Of Injury
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

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 7/26/2006
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
7/26/2006
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $95,000
Loss Adjust Expense Paid to Defense Counsel $4,063
All Other Loss Adjustment Expense Paid $2,705
Injured Person's Total Non-Economic Loss $95,000
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
Insurance company staff consulted with insured to discuss preventative measures. Risk management 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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