| Department File Number : | M201676980 |
| Claim Number : | 7012500 |
| Date Submitted : | 2/2/2016 |
| 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, Suite 650 | |||||
| City | State | Zip | |||
| Rosemont | IL | 60018 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (847) 653 - 8823 | (847) 653 - 8485 | janet.meyer@fortressins.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Despina | Angelakis | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 4350 Sheridan Street, Suite 201E | ||||
| City | State | Zip Code | County | ||
| Hollywood | FL | 33021 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 32022 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN15617 | Dentists | ||||
| 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 | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 5/20/2014 | 1/13/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient presented to the clinic with swelling and pain on the lower right side of his face. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The insured examined and evaluated the patient and proceeded with the agreed treatment plan and extracted teeth #s 31 and 32. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The patient alleged that the insured failed to manage the extraction procedure properly which resulted in the need for two additional surgical procedures. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 1/8/2016 | ||||
| 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 | |||||
| 1/22/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $400,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $17,929 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $3,720 | ||||||||||||||||||||
| 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. DESPINA ANGELAKIS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DESPINA ANGELAKIS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).