| Department File Number : | M201886933 |
| Claim Number : | HMA91267 |
| Date Submitted : | 11/6/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SHARI | R | MCGEE | ||
| Street Address | |||||
| 333 S. WABASH AVE. | |||||
| City | State | Zip | |||
| CHICAGO | IL | 60604 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (312) 822 - 2535 | shari.mcgee@cna.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Amber | Wiebe | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4942 US Highway 98 W Suite 19 | ||||
| City | State | Zip Code | County | ||
| Santa Rosa Beach | FL | 32459 | Walton | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNC 428206625 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN15518 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Okaloosa | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Dental Office | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/1/2018 | 3/27/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient alleges 2 root canal therapies failed and needed to be redone. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient alleges 2 root canal therapies failed and needed to be redone. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient alleges 2 root canal therapies failed and needed to be redone. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 10/5/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Settlement Reached Prior to Pre-Suit Period | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $475 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Enforcing guidelines and policies to prevent risks. | |||||||||||||||||||||
| 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 : | M201885535 |
| Claim Number : | HMA82844 |
| Date Submitted : | 6/11/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| CONTINENTAL CASUALTY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2114545 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SHARI | R | MCGEE | ||
| Street Address | |||||
| 333 S. WABASH AVE. | |||||
| City | State | Zip | |||
| CHICAGO | IL | 60604 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (312) 822 - 2535 | shari.mcgee@cna.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | AMBER | WIEBE | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4942 US HIGHWAY 98 W STE 19 | ||||
| City | State | Zip Code | County | ||
| SANTA ROSA BEACH | FL | 32459 | Walton | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNC 428206625 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN15518 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Walton | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Dental Office | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Special Procedure Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/17/2017 | 9/5/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| ALLEGED CROWN PLACED WITHOUT RCT; HAD TO GO TO ANOTHER DENTIST. IMPROPER PERFORMANCE. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| ALLEGED CROWN PLACED WITHOUT RCT; HAD TO GO TO ANOTHER DENTIST. IMPROPER PERFORMANCE. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| ALLEGED CROWN PLACED WITHOUT RCT; HAD TO GO TO ANOTHER DENTIST. IMPROPER PERFORMANCE. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 5/15/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| No Payment Made | |||||
| Court Decision | Other | ||||
| Other | Denied liability. | ||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Enforcing guidelines and policies to prevent risks. | |||||||||||||||||||||
| 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. AMBER WIEBE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. AMBER WIEBE, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).