Department File Number : | M201680333 |
Claim Number : | HMA49321 |
Date Submitted : | 11/18/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
CONTINENTAL CASUALTY COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-2114545 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Shauna | Jumper | |||
Street Address | |||||
333 S Wabash Ave | |||||
City | State | Zip | |||
Chicago | IL | 60604 | |||
Phone | Ext | Fax | E-Mail Address | ||
(312) 822 - 5419 | Shauna.Jumper@cna.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | HOWARD | M | CHASOLEN | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2033 Wood St Ste 125 | ||||
City | State | Zip Code | County | ||
Sarasota | FL | 34237 | Sarasota | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DLP 2011300638 | $2,000,000 | $4,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN13718 | Prosthodontics |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Sarasota | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Dental Office | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
7/1/2015 | 7/8/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Alleged problems with soft tissue and implants and prosthesis had to be remade. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Patient went in for dental work. She had maxillary implant treatment and had a temporary on the upper. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The insured did multiple revisions with her implants. | |||||
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 | 11/9/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
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 | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $65 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Investigate and identify risks and reduce the liability exposure. |
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. HOWARD M CHASOLEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. HOWARD M CHASOLEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).