Department File Number : | M201783266 |
Claim Number : | 346626 |
Date Submitted : | 10/4/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jessica | J | Macagno | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1935 West 60th Street | ||||
City | State | Zip Code | County | ||
Hialeah | FL | 33012 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0943946 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN19974 | 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 | ||||
Other Location | Miami Dental Center | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Dental Exam Room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/15/2015 | 8/25/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Failed implant. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Placement of dental implant on tooth #27. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None. | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff alleges she swallowed dental impression material resulting in a bowel obstruction which required 2 subsequent surgeries to resolve. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/18/2016 | 2016-019733-CA-01 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 9/28/2017 | ||||
Other Defendants Involved in this Claim | |||||
Miami Dental Center, 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 | |||||
9/28/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $240,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $25,119 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $27,559 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
Updates | |
No updates found. |
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Does Dr. JESSICA J MACAGNO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JESSICA J MACAGNO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).