Department File Number : | M201987534 |
Claim Number : | 1044459-01 |
Date Submitted : | 1/8/2019 |
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 | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | (260) 486 - 0782 | Lynn.Louthan@MEDPRO.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Charlotte | Y | Gerry | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 530 East Howard Street | ||||
City | State | Zip Code | County | ||
Live Oak | FL | 32064 | Suwannee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL010290 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14223 | Dentists - NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Suwannee | ||||
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 | ||||
4/27/2016 | 6/2/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
dental issues | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
dental extractions and implants placed | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
failure of implants | |||||
Principal Injury Giving Rise To The Claim | |||||
re-do dental work, residual unremitting pain | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
12/6/2017 | 2017CA000185CAAXMX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Suwannee | 1/7/2019 | ||||
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 | |||||
1/7/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $26,269 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $8,379 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $101,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
Updates | |
No updates found. |
Department File Number : | M201782100 |
Claim Number : | 1034075-01 |
Date Submitted : | 1/30/2018 |
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 | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | (260) 486 - 0782 | Lynn.Louthan@MEDPRO.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Charlotte | Y | Gerry | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 8750 Perimeter Park Blvd #101 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32216 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL010290 | $100,000 | $300,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14223 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
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 | insureds Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/28/2014 | 5/27/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Dental care | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
dental implant | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
improper dental care and treatment | |||||
Principal Injury Giving Rise To The Claim | |||||
surgical intervention and redo of procedure | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/11/2016 | 16-2016-CA-005243-XX | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 5/2/2017 | ||||
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 | |||||
5/2/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $75,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $19,984 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,486 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $64,927 | ||||||||||||||||||||
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: | 1/30/2018 1:28:52 PM | |||||||||
Reason for Change: | UPDATED ALE | |||||||||
|
This page is not displaying certain sensitive information.
Department File Number : | M201783070 |
Claim Number : | 1040578-01 |
Date Submitted : | 1/30/2018 |
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 | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | (260) 486 - 0782 | Lynn.Louthan@MEDPRO.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Charlotte | Y | GERRY | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 530 East Howard Street | ||||
City | State | Zip Code | County | ||
Live Oak | FL | 32064 | Suwannee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL010290 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14223 | Dentists - NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Suwannee | ||||
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 | ||||
9/26/2014 | 2/13/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
dental hygiene-tooth decay | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
placement of three dental implants | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
improper consent, care and follow up treatment | |||||
Principal Injury Giving Rise To The Claim | |||||
bone loss due to infection, need to redo work | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/27/2017 | 2017 CA 000016 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Flagler | 9/18/2017 | ||||
Other Defendants Involved in this Claim | |||||
Smile Design LLC | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $24,999 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $13,197 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $5,617 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $23,091 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
na |
Updates | ||||||||||
Date of Change: | 1/30/2018 2:09:51 PM | |||||||||
Reason for Change: | ALE UPDATED | |||||||||
|
This page is not displaying certain sensitive information.
Department File Number : | M201573649 |
Claim Number : | 1017705-01 |
Date Submitted : | 3/3/2015 |
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 | Charlotte | Y | Gerry | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 8750 Perimeter Park Blvd, # 101 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32216 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FL010290 | $100,000 | $300,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14223 | Dentists - N.O.C. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
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 | ||||
1/13/2014 | 1/21/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Dental issues | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Construct new partial | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Ancillary damage to crowned teeth | |||||
Principal Injury Giving Rise To The Claim | |||||
Crowned teeth broke off | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
1/16/2014 | 14-SC-173 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Duval | 2/23/2015 | ||||
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 | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Other | Not Pursued | ||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $1,053 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $11 | ||||||||||||||||||||
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 | |
No updates found. |
This page is not displaying certain sensitive information.
Does Dr. CHARLOTTE Y GERRY, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. CHARLOTTE Y GERRY, MD has at least 4 medical malpractice case(s), lawsuit(s), or complaint(s).