Department File Number : | M201576560 |
Claim Number : | 1009880-01 |
Date Submitted : | 8/9/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FLORIDA MEDICAL MALPRACTICE JUA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-1625412 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | SUSAN | SPIELMAN | |||
Street Address | |||||
5814 Reed Street | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0340 | (260) 486 - 0782 | SUSAN.SPIELMAN@MEDPRO.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Charles | A | Arias | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 17820 SE 109th Ave, Ste 111 | ||||
City | State | Zip Code | County | ||
Summerfield | FL | 34491 | Marion | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL002534 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN9145 | Dentists - N.O.C. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | 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 | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/14/2009 | 9/5/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Tooth pain | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Placement of veneers | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Improper performance | |||||
Principal Injury Giving Rise To The Claim | |||||
Failure of dental work; need to redo | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/24/2013 | 2012-CA-012873-O | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 12/8/2015 | ||||
Other Defendants Involved in this Claim | |||||
Heartland Dental Care Inc | |||||
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 | |||||
12/4/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $44,305 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $7,012 | ||||||||||||||||||||
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 | |||||||||||||||||||||
N/A |
Updates | ||||||||||
Date of Change: | 8/9/2016 2:29:15 PM | |||||||||
Reason for Change: | ALE UPDATED 8/9/2016 | |||||||||
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Does Dr. CHARLES A ARIAS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CHARLES A ARIAS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).