Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
Medical Malpractice Closed Claims Report
*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 : | M201573395 |
| Claim Number : | 7005255 |
| Date Submitted : | 5/20/2016 |
| 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 | Janet | L | Meyer | ||
| Street Address | |||||
| 6133 North River Rd., Suite 650 | |||||
| City | State | Zip | |||
| Rosemont | IL | 60018 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (847) 653 - 8823 | (847) 653 - 8485 | janet.meyer@fortressins.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jean | J | Edderai | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 17101 NE 19th Ave., Suite 104 | ||||
| City | State | Zip Code | County | ||
| North Miami Beach | FL | 33162 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 33086 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN12836 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| 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 | ||||
| 5/1/2009 | 7/2/2009 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient was initially seen on referral from her boyfriend for an evaluation for a slight upper overbite, crowded lower teeth, wisdom teeth issues and TMJ. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Following a thorough exam & evaluation including panoramic radiographs the insured followed the agreed treatment plan. The insured extracted teeth numbers 1 & 16. without incident. During the extraction of tooth 32 a cracking sound was noted. The insured obtained a radiograph which revealed a right lower border fracture. The insured immediately had the patient seen by an oral maxillofacial surgeon for surgical fixation and reduction of the mandible. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The patient alleges a jaw fracture due to the improper extraction of tooth 32. Patient also alleges possible paresthesia. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 4/28/2011 | 11-13327 CA 15 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 5/4/2016 | ||||
| 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 | |||||
| No Payment Made | |||||
| Court Decision | Other | ||||
| Judgment for the defendant. | |||||
| 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 | $152,891 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $23,998 | ||||||||||||||||||||
| 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 | |||||||||||||
| Date of Change: | 5/20/2016 9:39:39 AM | ||||||||||||
| Reason for Change: | Lawsuit refiled dismissal confirmed. Additional LAE incurred. | ||||||||||||
| |||||||||||||
*NR: Prior to 04/28/1999 this field was not required in submitted claims. This page is not displaying certain sensitive information.
Does Dr. JEAN EDDERAI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JEAN EDDERAI, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).