| Department File Number : | M201780766 |
| Claim Number : | 2015-119120 |
| Date Submitted : | 1/5/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-0687550 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Connie | L | Peters | ||
| Street Address | |||||
| PO Box 52810 | |||||
| City | State | Zip | |||
| Bellevue | WA | 98015 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (425) 636 - 1000 | 1012 | (916) 781 - 5795 | cpeters@intercareins.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Bryan | I | Gerstenberg | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 90 Garden Gate Cir | ||||
| City | State | Zip Code | County | ||
| Pensacola | FL | 32504 | Escambia | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU 083946784 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN13732 | Dental General Practice - NOC | 80211 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Escambia | ||||
| 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 | Dental treatment room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/15/2013 | 3/25/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient presented with a broken tooth | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The insured placed crowns for the patient. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis was made. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Subsequent loss of five teeth from ill fitting crowns. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 11/13/2015 | 34417734 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Escambia | 12/19/2016 | ||||
| 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 | |||||
| 12/6/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $20,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $11,441 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,375 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $20,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| No safety management steps taken | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. BRYAN I GERSTENBERG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BRYAN I GERSTENBERG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).