Department File Number : | M201988720 |
Claim Number : | 6033876 |
Date Submitted : | 5/10/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OMS NATIONAL INSURANCE COMPANY, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3571664 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Romelia | Alvarez | |||
Street Address | |||||
425 N Martingale Road Suite 900 | |||||
City | State | Zip | |||
Schaumburg | IL | 60173 | |||
Phone | Ext | Fax | E-Mail Address | ||
(847) 653 - 8823 | Romelia.Alvarez@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ludmils | Antonos | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 7352 Stonerock Circle Suite A | ||||
City | State | Zip Code | County | ||
Orlando | FL | 32819 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
2009938 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN20342 | Oral and Maxillofacial Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
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 | ||||
Patients' Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
2/16/2018 | 2/27/2018 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient presented for extraction of deciduous teeth A, J, M and R as well as exposure of palatially impacted tooth #6. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The doctor extracted tooth #7 along with teeth A, J, M and R and exposed tooth #6. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged improper extraction of tooth #7, which was a peg lateral. | |||||
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 | 12/23/2018 | ||||
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 | |||||
12/21/2018 |
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 | $7,742 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Documentation |
Updates | |
No updates found. |
Does Dr. LUDMILS ANTONOS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. LUDMILS ANTONOS, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).