| Department File Number : | M201989151 |
| Claim Number : | 5320181011004 |
| Date Submitted : | 6/24/2019 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| ASPEN SPECIALTY INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 06-1463851 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Nancy | c | Pistilli Hurst | ||
| Street Address | |||||
| 655 N Franklin Street | |||||
| City | State | Zip | |||
| Tampa | FL | 33602 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (813) 222 - 4186 | (813) 239 - 2663 | npistilli@bbprograms.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | CHARLES | J | ADELSON | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 7737 No University Drive | ||||
| City | State | Zip Code | County | ||
| Tamarac | FL | 33321 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| ES20181011004 | $500,000 | $1,500,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16482 | Dental General Practice - NOC | ||||
| 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 | ||||
| 6/16/2016 | 10/10/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Extraction of wisdom teeth | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Surgical extraction of partially impacted wisdom teeth #17 and #32 | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| alleged injury to the inferior aveolar nerve post extraction | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Permanent numbness to small area of lip and chin | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 3/28/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| Amores Dental Care PA | |||||
| 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 | |||||
| 3/28/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $60,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $10,117 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $60,000 | ||||||||||||||||||||
| Deductible | $5,000 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Defense counsel discussed risk management issues with insured | |||||||||||||||||||||
| Updates | |
| No updates found. |
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
*NR:Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Does Dr. CHARLES J ADELSON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CHARLES J ADELSON, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).