| Department File Number : | M201886061 |
| Claim Number : | HHD-0002286 |
| Date Submitted : | 8/2/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| HUDSON EXCESS INSURANCE COMPANY | Excess | ||||
| Insurer FEIN | Professional License Number | ||||
| 45-5271776 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yolanda | Burke | |||
| Street Address | |||||
| 851 Napa Valley Corporate Way, Suite N | |||||
| City | State | Zip | |||
| Napa | CA | 94558 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (707) 225 - 3331 | (707) 224 - 6858 | yburke@hudsoninsgroup.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Lona | Chen | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5165 S US Highway 1 | ||||
| City | State | Zip Code | County | ||
| Grant | FL | 32949 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| HCD4012341 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN22748 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Brevard | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Outpatient Facility | Dentist office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Patients room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/20/2017 | 1/9/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient presented for two fillings | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| two fillings | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| TMJ | |||||
| Severity Of Injury | |||||
| Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 6/25/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within 90 days of suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 7/11/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $250,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $10,521 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $1,608 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Unknown at this time | |||||||||||||||||||||
| 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. LONA CHEN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LONA CHEN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).