| Department File Number : | M201886912 |
| Claim Number : | 362841 |
| Date Submitted : | 11/2/2018 |
| 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 | Kelly | Andrews | |||
| Street Address | |||||
| 12724 Gran Bay Parkway, W., Suite 400 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kevin | V | Diep | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1761 SE Port Saint Lucie Blvd. | ||||
| City | State | Zip Code | County | ||
| Port Saint Lucie | FL | 34952 | St. Lucie | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0950277 | $500,000 | $1,500,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16316 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | St. Lucie | ||||
| 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 Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/1/2017 | 11/13/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Infected tooth #32. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Insured extracted tooth #31 instead if #32. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Extracted the incorrect tooth. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Extraction of tooth #31 requiring replacement with dental implant. | |||||
| 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 | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 10/9/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed). | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 10/9/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $25,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $1,232 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $519 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. | |||||||||||||||||||||
| 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.
| Department File Number : | M201987994 |
| Claim Number : | 369339 |
| Date Submitted : | 2/22/2019 |
| 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 | Kelly | Andrews | |||
| Street Address | |||||
| 12724 Gran Bay Parkway, W., Suite 400 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32258 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 360 - 3038 | kandrews@thedoctors.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kevin | V | Diep | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1761 SE Port Saint Lucie Blvd. | ||||
| City | State | Zip Code | County | ||
| Port Saint Lucie | FL | 34952 | St. Lucie | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0950277 | $500,000 | $1,500,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16316 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | St. Lucie | ||||
| 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 office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 1/5/2017 | 5/7/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient sought treatment for damaged teeth with cosmetic veneers. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| During crown prep on anterior maxillary teeth, high speed bur slipped and lacerated patient's lip. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| There was none. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Laceration on patient's lip. | |||||
| Severity Of Injury | |||||
| Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 5/3/2018 | 052016CA023727X | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Brevard | 2/4/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| Smile Brands East, Inc. Diep, DMD, Kevin V Valley Forge Dental of Florida, PA | |||||
| 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 | |||||
| 2/4/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $22,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $8,683 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $527 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $22,000 | ||||||||||||||||||||
| 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. KEVIN V DIEP, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. KEVIN V DIEP, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).