| Department File Number : | M202091013 |
| Claim Number : | 7032526 |
| Date Submitted : | 1/6/2020 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| FORTRESS INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-4159841 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | FLORENCE | R | MARAFATSOS | ||
| Street Address | |||||
| 425 N. Martingale Road | |||||
| City | State | Zip | |||
| Schaumburg | IL | 60173 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (800) 522 - 6675 | 8466 | (847) 653 - 8486 | ERICA.AMES@FORTRESSINS.COM | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Margo | K | Brilliant | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 18851 NW 29th Avenue, Suite 300 | ||||
| City | State | Zip Code | County | ||
| Aventura | FL | 33180 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 32984 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN9558 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Dade | ||||
| 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 | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 7/26/2016 | 3/28/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Maligned teeth requiring orthodontic care. Orthodontic care. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Maligned teeth requiring orthodontic care. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Failure of treatment. | |||||
| 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 | 12/19/2019 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| After arbitration is initiated or prior to suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Award for plaintiff. | |||||
| Date of Payment | |||||
| 12/23/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $30,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $259 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| documentation | |||||||||||||||||||||
| Updates | |
| No updates found. |
Does Dr. MARGO K BRILLIANT, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARGO K BRILLIANT, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).