Department File Number : | M201575287 |
Claim Number : | FP4247101 |
Date Submitted : | 7/22/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6614702 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parway 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 | Brian | Coleman | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7200 Aloma Avenue, Suite D | ||||
City | State | Zip Code | County | ||
Winter Park | FL | 32792 | Orange | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-IN061586 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN11787 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Orange | ||||
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 | ||||
Other | Physician's Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
9/6/2011 | 12/5/2011 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient sought dental evaluation and cleaning. The diagnosis was impacted teeth. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The patient underwent extraction of teeth #1 and #2. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
It is alleged that the insured failed to obtain informed consent before proceeding with dental treatment. | |||||
Principal Injury Giving Rise To The Claim | |||||
Fracture right mandible. | |||||
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 | ||||
1/28/2014 | 2014-CA-000978-0 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 6/25/2015 | ||||
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 | ||||
Other | Settled | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $299,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $50,982 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $29,890 | ||||||||||||||||||||
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. BRIAN COLEMAN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BRIAN COLEMAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).