| Department File Number : | M201782720 |
| Claim Number : | 2644821 |
| Date Submitted : | 8/4/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| THE CINCINNATI INDEMNITY COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 31-1241230 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Heather | N | Hartman | ||
| Street Address | |||||
| 6200 South Gilmore Road | |||||
| City | State | Zip | |||
| Fairfield | OH | 45014 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (513) 603 - 5846 | (513) 371 - 7028 | Heather_Hartman@CINFIN.COm | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jeffrey | Ellenberg | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1430 Belcher Road S | ||||
| City | State | Zip Code | County | ||
| Clearwater | FL | 33764 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| CAP 5131060 | $1,000,000 | $2,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN11742 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | 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 | ||||
| 2/1/2014 | 4/8/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Clmt is alleging insd was negligent in the installation of crowns. Insd replaced clmt's crowns several times due to clmt's allegations of discoloring. With the final installation of crowns there was swelling the insd noticed and a cant. Insd tried to refer clmt to another dentist but to no avail. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Insd replaced 10 crowns for clmt. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Clmt is alleging insd was negligent in the installation of crowns. Insd replaced clmt's crowns several times due to clmt's allegations of discoloring. With the final installation of crowns there was swelling the insd noticed and a cant. Insd tried to refer clmt to another dentist but to no avail. | |||||
| Severity Of Injury | |||||
| Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 8/3/2017 | ||||
| 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 | |||||
| 8/3/2017 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $50,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $29,968 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| None given | |||||||||||||||||||||
| 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. JEFFREY ELLENBERG, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JEFFREY ELLENBERG, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).