PLCR

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201676882
Claim Number : 43812-1
Date Submitted : 1/21/2016
 
Insurer Information
 
Insurer Name Coverage Type
LANCET INDEMNITY RISK RETENTION GROUP INC. Primary
Insurer FEIN Professional License Number
26-1479165  
Insurer Contact Information
Type First Name MI Last Name
Individual Christopher   Teter
Street Address
2810 West St. Isabel Street Suite 100
City State Zip
Tampa FL 33602
Phone Ext Fax E-Mail Address
(813) 290 - 8282 265   cteter@lancetindemnity.com
 
Insured Information
 
Type First Name MI Last Name
Individual Mario   Diaz
Insurer Type Street Address of Practice
Licensed 10120 SW 81 St.
City State Zip Code County
Miami FL 33173 Dade
Policy Number Per Claim Policy Limits Aggregate Policy Limits
LR091111000640 $100,000 $300,000
Profession or Business Other Profession or Business
Medical Doctor  
License Number Specialty Code & Classification Certification Number
ME39292 Anesthesiology  

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 Broward
City State Zip Code
     
Location where injury occured Other location where injury occured
Hospital Outpatient Facility  
Name of Institution Code
CORAL GABLES SURGERY CENTER 14960466
Location of Institutional Injury Other Location of Institutional Injury
Operating Suite  
Date of Occurrence Date Reported to Insurer
8/12/2013 4/17/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Claimant presented for a breast augmentation.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Claimant underwent elective breast augmentation.
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
Alleged excessive amounts of sedative that caused a severe brain injury.
Severity Of Injury
Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

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 12/14/2015
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
12/14/2015
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $100,000
Loss Adjust Expense Paid to Defense Counsel $6,000
All Other Loss Adjustment Expense Paid $0
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 $100,000 $0
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely
Insurer is not aware of what steps have been taken.
 
Updates
 
No updates found.

 

 

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

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