Department File Number : | M201988704 |
Claim Number : | 2016-122822 |
Date Submitted : | 5/9/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
Insurer FEIN | Professional License Number | ||||
25-0687550 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Connie | L | Peters | ||
Street Address | |||||
PO Box 52810 | |||||
City | State | Zip | |||
Bellevue | WA | 98015 | |||
Phone | Ext | Fax | E-Mail Address | ||
(425) 636 - 1000 | 1012 | (916) 781 - 5795 | cpeters@intercareins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Juan | M | Teodoro | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 9510 Bonita Beach Rd, Ste 102 | ||||
City | State | Zip Code | County | ||
Bonita Springs | FL | 34135 | Lee | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DNU060250581 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN17032 | Dental General Practice - NOC | 80211 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Lee | ||||
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 | ||||
Other | Dental treatment room | ||||
Date of Occurrence | Date Reported to Insurer | ||||
6/8/2015 | 12/12/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Periodontal Infection | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Mucogingival Surgery | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Undiagnosed infection | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged failure to diagnose infection and unnecessary allograft surgery resulting in alleged Trigeminal Neuralgia | |||||
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 | ||||
8/31/2017 | 17CA002299 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Lee | 4/25/2019 | ||||
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 | |||||
4/24/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $55,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $31,154 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $7,943 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $53,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
No safety management steps taken. |
Updates | |
No updates found. |
Does Dr. JUAN M TEODORO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. JUAN M TEODORO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).