Department File Number : | M201990405 |
Claim Number : | 341612 |
Date Submitted : | 10/28/2019 |
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 | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, 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 | Charles | M | Wallace | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4743 Pinfish Court | ||||
City | State | Zip Code | County | ||
Bonita Springs | FL | 34135 | Lee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0951958 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14024 | Dental General Practice - NOC |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Lee | ||||
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 | Dentist's office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/15/2016 | 4/18/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient presented for extraction of teeth #'s 17 and 18 and cyst removal on tooth #17. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The teeth were extracted and upon the cyst removal the socket started to bleed uncontrollably. The patient had signed a consent that indicated the risks associated with the procedure. The insured packed the socket with gauze but the bleeding did not diminish. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient alleged lingual nerve damage. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
9/6/2017 | 17-CA-002911 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lee | 10/24/2019 | ||||
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 | |||||
10/24/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $135,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $73,672 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $33,813 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $135,000 | ||||||||||||||||||||
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. |
Does Dr. CHARLES M WALLACE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CHARLES M WALLACE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).