PLCR

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 
Department File Number : M201885305
Claim Number : 155111
Date Submitted : 4/10/2019
 
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
1100 Dr. Martin Luther King Jr. Blvd, Ste. 500
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 Entity Name
Entity WESTSIDE REGIONAL MEDICAL CENTER
Insurer Type Street Address of Practice
Licensed 8201 WEST BROWARD BLVD
City State Zip Code County
PLANTATION FL 33324 Broward
Policy Number Per Claim Policy Limits Aggregate Policy Limits
HCI-10114 $5,000,000 $10,000,000
Profession or Business Other Profession or Business
Hospitals  
License Number Specialty Code & Classification Certification Number
     

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
WESTSIDE REG. MED. CTR (PLANTATION) 100228
Location of Institutional Injury Other Location of Institutional Injury
Other INTENSIVE CARE UNIT
Date of Occurrence Date Reported to Insurer
11/23/2014 5/5/2015
 
Diagnostic Information
 
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
DIAGNOSED WITH DVT
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
FAILURE TO DIAGNOSE AND TREAT PULMONARY EMBOLISM
Diagnostic Code :  
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
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
11/16/2016 CACE-16-021195
County Suit Filed in Date of Final Disposition
Broward 4/10/2019
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
3/16/2018
 
Financial Information
 
Was there a settlement Resulting in payment to the Plaintiff? Yes
Indemnity Paid by Insurer on behalf of Insured $1,050,000
Loss Adjust Expense Paid to Defense Counsel $113,878
All Other Loss Adjustment Expense Paid $29,193
Injured Person's Total Non-Economic Loss $1,050,000
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
REVIEW OF POLICIES AND PROCEDURES
 
Updates
 
No updates found.

 

 

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

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