Department File Number : | M201885671 |
Claim Number : | 7031071 |
Date Submitted : | 6/20/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FORTRESS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-4159841 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Erica | Ames | |||
Street Address | |||||
6133 N. River Road, Suite 650 | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(847) 653 - 8832 | erica.ames@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Alexander | O | Lopez | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1235 Alton RD | ||||
City | State | Zip Code | County | ||
Miami Beach | FL | 33139 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
3009383 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN13015 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Dade | ||||
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 | ||||
5/22/2015 | 8/1/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented for extraction of teeth #1, #16 and #32 due to pain. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient signed a consent form and all three teeth were extracted. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient alleged a linqual nerve injury resulting in permanent numbness to the right side of her tongue. No subsequent surgery was done. | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/18/2017 | 2014-020296-CA-01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 5/30/2018 | ||||
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 | |||||
6/8/2018 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $70,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $21,880 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown |
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.
Department File Number : | M201574799 |
Claim Number : | 7010917 |
Date Submitted : | 6/2/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FORTRESS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-4159841 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Janet | L | Meyer | ||
Street Address | |||||
6133 North River Road, Ste. 650 | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(846) 653 - 8823 | (847) 653 - 8485 | janet.meyer@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Alexander | O | Lopez | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1235 Alton Road | ||||
City | State | Zip Code | County | ||
Miami Beach | FL | 33139 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
3009383 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN13015 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Dade | ||||
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 | ||||
11/9/2011 | 10/2/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient presented to the insured for root canal treatment of tooth #18. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The insured performed root canal treatment on tooth #18. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged loss of tooth #18 following root canal treatment. | |||||
Severity Of Injury | |||||
Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/1/2014 | 14-008465 CA 01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 5/25/2015 | ||||
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 | |||||
5/26/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $27,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $10,344 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $2,659 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown |
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.
Does Dr. ALEXANDER O LOPEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ALEXANDER O LOPEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).