Department File Number : | M201575315 |
Claim Number : | HMA25618 |
Date Submitted : | 7/23/2015 |
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 | Marina | Miranda | |||
Street Address | |||||
333 S Wabash Ave | |||||
City | State | Zip | |||
Chicago | IL | 60604 | |||
Phone | Ext | Fax | E-Mail Address | ||
(312) 822 - 2261 | marina.miranda@cna.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | John | C | Klemes | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1017 Barcarmil Way | ||||
City | State | Zip Code | County | ||
Naples | FL | 34110 | Collier | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DNC 166884201 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN12518 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Collier | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Outpatient Facility | 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 | ||||
4/7/2014 | 4/7/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented for dentures. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Precision measurements done for dentures. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Partial did not fit properly. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
10/17/2014 | 11-2014-SC-001380-00 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Collier | 7/1/2015 | ||||
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 | ||||
Other | Claim dismissed without prejudice | ||||
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 | $1,686 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $200 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Control internal processes or action that reduces the likelihood of undesirable events. |
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. JOHN C KLEMES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JOHN C KLEMES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).