Department File Number : | M201676864 |
Claim Number : | 7012521 |
Date Submitted : | 1/19/2016 |
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 | |||||
6133 N. River Road | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(847) 653 - 8466 | (847) 653 - 8486 | florence.marafatsos@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Harris | L | Rittenberg | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 5417 Ortega Blvd | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32210 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
31974 | $500,000 | $1,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN10140 | Dentists |
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 | ||||
3/20/2013 | 1/26/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented to the insured for evaluation and treatment of her collapsed bite. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
After being informed of different treatment options, the patient chose mini implants. The insured placed the mini implants and delivered restorative crowns. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
None, the patient alleged improper performance as implants failed to integrate. | |||||
Principal Injury Giving Rise To The Claim | |||||
Despite numerous adjustments, the mini implants were subsequently removed because of alleged pain and cheek/tongue biting. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 12/23/2015 | ||||
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 | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
12/23/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $85,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $10,132 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Unknown |
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. HARRIS L RITTENBERG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. HARRIS L RITTENBERG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).