Department File Number : | M201679228 |
Claim Number : | 6385 |
Date Submitted : | 7/21/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NCMIC INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
42-0635534 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jonny | Workman | |||
Street Address | |||||
17840 Toledo Blade Blvd | |||||
City | State | Zip | |||
Port Charlotte | FL | 33948 | |||
Phone | Ext | Fax | E-Mail Address | ||
(941) 627 - 5858 | (941) 627 - 5858 | manager@paradisedentalpc.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | W | Rowe | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 17840 Toledo Blade Blvd | ||||
City | State | Zip Code | County | ||
Port Charlotte | FL | 33948 | Charlotte | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DPL035541 | $11,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14150 | Dentists - NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Charlotte | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | Paradise Dental | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Operatory | ||||
Date of Occurrence | Date Reported to Insurer | ||||
4/20/2015 | 10/15/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Extractions of third molars was given due to the re-occurance of the periodontal disease on her molars even after periodontal surgery and subsequent periodontal recall appointments | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
After Re-evaluating the teeth to be extracted, I discovered that #2 (1 or 2 written in notes) had a 6mm bleeding pocket on the entire mesial. The teeth were then locally anesthetized. The decision was made that since I was extracting #16,17 and 32 due to refractory periodontal disease reasons and #2 (or #1) was now nearly a non-functional tooth. I would extract it for the same reasons. The assistant at the time was informed to add #2(1) to the consent form.Routine sterile surgical extractions were then preformed. The patient was called later that day to check on her post op recovery, as well as re-discuss reasons for extracting #2(1). The patient was informed once again "If you were my mother, I would have recommended removing #2(1)." | |||||
Diagnostic Code : | d7210 | ||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
The misdiagnosis was only that the patient should have been informed and discussed before the local anesthetic was given. Also that the assistant who added #2 to the consent form, did NOT make a new consent form with only #2(1) on it she "squeezed" it into the original signed consent form. | |||||
Principal Injury Giving Rise To The Claim | |||||
Loss of #2(1) only is the fact that she lost 10-20 % chewing surface of its opposing tooth #31. All periodontal conditions associated with #3 distal most likely healed ideally. | |||||
Severity Of Injury | |||||
Emotional Only - Fright, no physical damage |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/15/2015 | 63485 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Charlotte | 4/13/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/13/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $30,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Risk training to ensure patient fully understands treatment being performed. Consent forms cannot have anything added after the patient has signed even if they understand. |
Updates | |
No updates found. |
This page is not displaying certain sensitive information.
Department File Number : | M201781184 |
Claim Number : | 63485 |
Date Submitted : | 2/10/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NCMIC INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
42-0635534 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michelle | R | Gould | ||
Street Address | |||||
14001 University Avenue | |||||
City | State | Zip | |||
Clive | IA | 50325 | |||
Phone | Ext | Fax | E-Mail Address | ||
(515) 313 - 4558 | (515) 313 - 4471 | mgould@ncmic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Rowe | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 17840 Toledo Blade Blvd Unit A | ||||
City | State | Zip Code | County | ||
Port Charlotte | FL | 33948 | Charlotte | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DPL035541 | $1,100,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14150 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Charlotte | ||||
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 | ||||
4/20/2015 | 10/20/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient was to have three teeth removed. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Insured was to extract teeth #16, #17 and #32; however during procedure he felt #1 needed to be removed due to periodontal issues | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Insured was to extract teeth #16, #17 and #32; however during procedure he felt #1 needed to be removed due to periodontal issues and without getting prior consent. Extracted #1; however #1 had been previously removed and insured extracted #2. | |||||
Principal Injury Giving Rise To The Claim | |||||
Insured was to extract teeth #16, #17 and #32; however during procedure he felt #1 needed to be removed due to periodontal issues and without getting prior consent. Extracted #1; however #1 had been previously removed and insured extracted #2. | |||||
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 | 4/13/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/13/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $30,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $600 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unsure what safety management steps taken |
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.
Department File Number : | M202091621 |
Claim Number : | 63485 |
Date Submitted : | 2/24/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NCMIC INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
42-0635534 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Michelle | R | Gould | ||
Street Address | |||||
14001 University Avenue | |||||
City | State | Zip | |||
Clive | IA | 50325 | |||
Phone | Ext | Fax | E-Mail Address | ||
(515) 313 - 4558 | (515) 313 - 4471 | mgould@ncmic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | David | Rowe | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 17840 Toldeo Blade Blvd Unit A | ||||
City | State | Zip Code | County | ||
Port Charlotte | FL | 33948 | Charlotte | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DPL35541 | $1,100,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14150 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Charlotte | ||||
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 | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
4/20/2015 | 10/20/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient was to have three teeth removed. #16,17 and 32 | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Doctor extracted four teeth | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
During procedure doctor felt #1 needed to be removed due to periodontal issues and without getting prior consent extracted #1. However, #1 had been previously removed and doctor extracted #2 although his records showed #1. | |||||
Principal Injury Giving Rise To The Claim | |||||
Settlement was reached directly with attorney representing patient in an effort to avoid court filing fees. | |||||
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 | 4/13/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Settlement Reached Prior to Pre-Suit Period | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
4/13/2016 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $30,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $600 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown |
Updates | |
No updates found. |
Does Dr. DAVID W ROWE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. DAVID W ROWE, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).