| Department File Number : | M201677790 |
| Claim Number : | 1009884-01 |
| Date Submitted : | 8/9/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FLORIDA MEDICAL MALPRACTICE JUA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 59-1625412 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | SUSAN | SPIELMAN | |||
| Street Address | |||||
| 5814 Reed Street | |||||
| City | State | Zip | |||
| Fort Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0340 | (260) 486 - 0782 | SUSAN.SPIELMAN@MEDPRO.COM | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Carlos | F | Johary | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 11905 US Highway 301 North | ||||
| City | State | Zip Code | County | ||
| Oxford | FL | 34484 | Sumter | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| FL010621 | $250,000 | $750,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN13227 | Dentists - N.O.C. | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Lake | ||||
| 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 | ||||
| 11/3/2011 | 8/22/2012 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Dental pain | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Implant | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Improper treatment | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Failure of implant; pain and suffering, dental expense | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/11/2012 | 2012-CA-000887 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Sumter | 3/28/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| Oxford Dental Care LLC | |||||
| 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 | |||||
| 3/25/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $3,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $15,615 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,753 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| N/A | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 4/1/2016 2:16:42 PM | |||||||||
| Reason for Change: | Corrected city, state, zip - insured's address | |||||||||
| ||||||||||
| Date of Change: | 8/9/2016 2:30:47 PM | |||||||||
| Reason for Change: | ALE UPDATED 8/9/2016 | |||||||||
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Does Dr. CARLOS F JOHARY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CARLOS F JOHARY, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).