Dr. DONALD VAN, MD Medical Malpractice Cases, Lawsuits, and Complaints

Phycicians Practice Address

Dr. DONALD VAN, MD

2410 S Florida Avenue

Indemnity Paid: $6,500.00

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	Donald			Van
Insurer Type		Street Address of Practice
Licensed		2410 S Florida Avenue
City		State	Zip Code	County
Lakeland		FL	33813	Polk
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
DPL046556		$1,100,000		$3,000,000
Profession or Business			Other Profession or Business
Dentistry
License Number		Specialty Code & Classification		Certification Number
DN20242		Dental General Practice - NOC

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Polk
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
1/10/2019		7/17/2019

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Patient presented for dental procedure for some gum disease
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Electrosurge utensil to remove gum tissue
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Allegations were that the patient's lip and face sustained a cut from the electrosurge resulting in a small scar.
Principal Injury Giving Rise To The Claim
Settlement was reached to avoid the costs and uncertainties of ligitation and is in no way an admission of liability or wrong doing.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Legal Information

Date of Suit			Circuit Court Case Number
			*NR
County Suit Filed in			Date of Final Disposition
*NR			8/1/2019
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

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$6,500

Loss Adjust Expense Paid to Defense Counsel

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

Unsure

Does Dr. DONALD VAN, MD have any medical malpractice cases, lawsuits, or complaints?

Dr. DONALD VAN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).

Medical Malpractice Cases