Department File Number : | M202091540 |
Claim Number : | 7031824 |
Date Submitted : | 2/19/2020 |
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 | FLORENCE | R | MARAFATSOS | ||
Street Address | |||||
425 N. Martingale Road | |||||
City | State | Zip | |||
Schaumburg | IL | 60173 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 522 - 6675 | 8466 | (847) 653 - 8486 | ERICA.AMES@FORTRESSINS.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | ANTHONY | J | VISCONTI | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 333 East New York Avenue, Suite B | ||||
City | State | Zip Code | County | ||
Deland | FL | 32724 | Volusia | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
37233 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14130 | Dental General Practice - NOC |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Volusia | ||||
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 | ||||
1/25/2017 | 6/8/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Tooth #3 was badly decayed and needed to be prepared for a crown. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
No treatment was rendered - plan was to prep the tooth for a crown but the patient left without receiving treatment. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleged that since the doctor did not treat tooth #3 at scheduled visit to remove decay, she was caused to seek care elsewhere and had to undergo a root canal. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
7/3/2019 | 2019 10640 CIDL | ||||
County Suit Filed in | Date of Final Disposition | ||||
Volusia | 2/10/2020 | ||||
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 | |||||
2/17/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $17,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $26,509 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
documentation |
Updates | |
No updates found. |
Does Dr. ANTHONY J VISCONTI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANTHONY J VISCONTI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).