Department File Number : | M202092538 |
Claim Number : | MM266304-2 |
Date Submitted : | 5/21/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
EVANSTON INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-2950161 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Latissa | Sims | |||
Street Address | |||||
10275 WEST HIGGINS ROAD, SUITE 750 | |||||
City | State | Zip | |||
ROSEMONT | IL | 60015 | |||
Phone | Ext | Fax | E-Mail Address | ||
(804) 287 - 6997 | latissa.sims@markel.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | LEROY | R | POLITE | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 1680 Dunn Ave Ste 31 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32218 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
MM821903 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN8243 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | DENTAL OFFICE | ||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | DENTAL OFFICE | ||||
Date of Occurrence | Date Reported to Insurer | ||||
12/3/2010 | 4/5/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient visited facility to have teeth removed and to get dentures | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Another dentist working at insured facility allegedly overdosed the patient with lidocaine. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Due to the alleged overdoes of lidocaine, the patient was caused to have permanent numbness in his face, lips, tongue, and loss of taste. | |||||
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 | ||||
7/15/2013 | 2013-CA-004147 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 1/29/2020 | ||||
Other Defendants Involved in this Claim | |||||
MOFFETT, DDS, ROBERT P | |||||
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 | |||||
12/3/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $443,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $543,090 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $10,000 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
NONE |
Updates | |
No updates found. |
Does Dr. LEROY R POLITE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LEROY R POLITE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).