| Department File Number : | M201574618 |
| Claim Number : | 305278 |
| Date Submitted : | 5/14/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-3014772 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Tiffany | D | Taylor | ||
| Street Address | |||||
| 13450 West Sunrise Blvd | |||||
| City | State | Zip | |||
| Sunrise | FL | 33323 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (877) 320 - 0748 | TTaylor@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jorge | Hernandez | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 6080 SW 40th Street #8 | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33155 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0907627 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Medical Doctor | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN11612 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Dade | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Practitioner's Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/14/2010 | 4/22/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient sought treatment for periodontal disease and poor oral hygiene. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The patient underwent extractions of teeth and placement of crowns and bridges. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Alleged failure to provide appropriate and properly fitting bridges and crowns. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Infection of gums and teeth. | |||||
| Severity Of Injury | |||||
| Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 9/10/2013 | 13-028410 CA 01 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 5/4/2015 | ||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 5/7/2015 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $115,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| The insured conferenced with his attorneys and claims adjuster. | |||||||||||||||||||||
| Updates | |
| No updates found. |
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| Department File Number : | M202091482 |
| Claim Number : | 347833 |
| Date Submitted : | 2/14/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-3014772 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Dawn | Owens | |||
| Street Address | |||||
| 12724 GRAN BAY PKWY W, Suite 400 | |||||
| City | State | Zip | |||
| JACKSONVILLE | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3044 | dowens@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Jorge | O | Hernandez | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 6080 Bird Road, Suite 8 | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33155 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0907627 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN11612 | Dental General Practice - NOC | ||||
| 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 | ||||
| Other Hospital/Institution | Heartland of Boynton Beach, FL, LLC | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physician's Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 12/11/2014 | 9/29/2016 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The patient presented for an upper bridge. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The patient alleged the bridge had open margins and was ill fitting and compromised the teeth. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The patient alleged the bridge compromised her teeth. | |||||
| Severity Of Injury | |||||
| Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 6/13/2017 | 17-11317-CA 01 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Dade | 2/13/2020 | ||||
| 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 | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 2/13/2020 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $48,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $58,489 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $58,111 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $48,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. JORGE HERNANDEZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JORGE HERNANDEZ, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).