| Department File Number : | M202091346 |
| Claim Number : | 7031833 |
| Date Submitted : | 2/5/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FORTRESS INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-4159841 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | FLORENCE | R | MARAFATSOS | ||
| Street Address | |||||
| 425 N. Martingale Road | |||||
| City | State | Zip | |||
| Schaumburg | IL | 60173 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (800) 522 - 6675 | 8466 | (847) 653 - 8486 | ERICA.AMES@FORTRESSINS.COM | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | DAVID | SHERBERG | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5008 34th Street South | ||||
| City | State | Zip Code | County | ||
| St. Petersburg | FL | 37711 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 3009921 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN20026 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| 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 | ||||
| 5/24/2016 | 6/13/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Insured extracted tooth #17. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Patient complained of 9/10 pain in her lower left wisdom tooth #7. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient alleged lingual and IAN injury. A subsequent treator performed surgery and removed a large neuroma on the left lingual nerve. The nerve was otherwise intact on the proximal and distal aspect. No surgery to IAN. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 4/13/2018 | 18-002316-C1 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 1/23/2020 | ||||
| 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 | |||||
| Award for plaintiff. | |||||
| Date of Payment | |||||
| 1/30/2020 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $92,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $44,779 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| documentation | |||||||||||||||||||||
| Updates | |
| No updates found. |
| Department File Number : | M201885960 |
| Claim Number : | 7031833 |
| Date Submitted : | 7/20/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FORTRESS INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-4159841 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Erica | A | Ames | ||
| Street Address | |||||
| 6133 N. RIVER ROAD | |||||
| City | State | Zip | |||
| ROSEMONT | IL | 60018 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (800) 522 - 6675 | 8832 | (847) 653 - 8486 | ERICA.AMES@FORTRESSINS.COM | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | David | Sherberg | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5008 34th Street, South | ||||
| City | State | Zip Code | County | ||
| St. Petersburg | FL | 33711 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 3009921 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN20026 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pinellas | ||||
| 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 | ||||
| 5/24/2016 | 6/13/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Parasthesia of anterior 2/3 of tongue. Extraction tooth #17 | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Improper performance of surgery | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Improper performance of surgery | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Improper performance of surgery | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 6/22/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| No Payment Made | |||||
| 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? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $1,468,100 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $146,557 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| documentation | |||||||||||||||||||||
| Updates | |
| No updates found. |
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. DAVID SHERBERG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID SHERBERG, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).