Department File Number : | M202091067 |
Claim Number : | 7031869 |
Date Submitted : | 1/10/2020 |
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 | Fanny | E | Rovira | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 120 1st Avenue Southwest | ||||
City | State | Zip Code | County | ||
Largo | FL | 33770 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
3015818 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN12953 | 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 | ||||
4/26/2016 | 6/30/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Alleges placement of bridge & crowns #4-14 caused her an off bite, and unhappy aesthetic result. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Placement of bridge and crowns at #4-14. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient wanted new teeth and "couldn't wait to eat well" again. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/10/2018 | 18-06665-CI | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 1/10/2020 | ||||
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 | |||||
1/6/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $27,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $23,764 | ||||||||||||||||||||
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. |
Does Dr. FANNY E ROVIRA, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. FANNY E ROVIRA, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).