Department File Number : | M201472006 |
Claim Number : | 1853605 |
Date Submitted : | 9/22/2014 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
THE CINCINNATI INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
31-0542366 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Heather | N | Hartman | ||
Street Address | |||||
6200 South Gilmore Road | |||||
City | State | Zip | |||
Fairfield | OH | 45014 | |||
Phone | Ext | Fax | E-Mail Address | ||
(513) 603 - 5846 | (513) 371 - 7028 | Heather_Hartman@CINFIN.COm |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Adrian | Rivas | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 13876 SW 88 St | ||||
City | State | Zip Code | County | ||
Miami | FL | 33186 | Dade | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CAP 5186111 | $1,000,000 | $2,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN18500 | Dental Public Health |
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 | ||||
3/6/2012 | 9/14/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Clmt alleges that after a rt lower molarextraction she required hospitalization for sepsis, hypotention, and developed acute renal failure, meningitis, and was treated for culture negative endocarditis. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Clmt alleges that after a rt lower molarextraction she required hospitalization for sepsis, hypotention, and developed acute renal failure, meningitis, and was treated for culture negative endocarditis. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Clmt alleges that after a rt lower molarextraction she required hospitalization for sepsis, hypotention, and developed acute renal failure, meningitis, and was treated for culture negative endocarditis. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/26/2013 | 13-00241CA15 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Dade | 9/19/2014 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
9/19/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $310,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $28,031 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $3,328 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None given. |
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 : | M201472502 |
Claim Number : | 309260 |
Date Submitted : | 10/31/2014 |
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 | Tiffany | D | Taylor | ||
Street Address | |||||
13450 West Sunrise Blvd | |||||
City | State | Zip | |||
Sunrise | FL | 33323 | |||
Phone | Ext | Fax | E-Mail Address | ||
(877) 320 - 0748 | TTaylor@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Adrian | A | Rivas | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 217 Lexinton Court | ||||
City | State | Zip Code | County | ||
Grayslake | IL | 60030 | Out of state | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0947029 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN18500 | Periodontics |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Physician's Office | |||||
Name of Institution | Code | ||||
N/A | 000000 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Practitioner's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/6/2012 | 8/13/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Tooth extraction & gum surgery. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Contraindicated medication administered. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Renal failure. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/26/2013 | 13-00241CA15 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Columbia | 10/21/2014 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
10/13/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $155,000 | ||||||||||||||||||||
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 | |||||||||||||||||||||
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. ADRIAN RIVAS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ADRIAN RIVAS, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).