| Department File Number : | M201678851 |
| Claim Number : | C156569 |
| Date Submitted : | 6/28/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| ADMIRAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 22-2235730 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Angela | Rando | |||
| Street Address | |||||
| 1000 Howard Boulevard Suite 300 | |||||
| City | State | Zip | |||
| Mount Laurel | NJ | 08054 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (856) 857 - 3367 | arando@admiralins.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mark | H | Zahler | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 10051 Pines Blvd #d | ||||
| City | State | Zip Code | County | ||
| Pembroke Pines | FL | 33024 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| EO000007334-06 | $200,000 | $600,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN13388 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Broward | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Physician's Office | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Dentist Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 8/15/2011 | 11/13/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Planned repositioning of upper anterior crowns that were to be supported by implants. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Extracted teeth #6 and #11, the upper canines, which are the structural keystone of the dental arch thus improperly weakening the strength and integrity of the support needed for fixed dental restorations. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Teeth should not have been removed. Instead of an 8-unit bridge, a 12-unit bridge was required. | |||||
| 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 | 6/3/2016 | ||||
| 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 | |||||
| 6/6/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $90,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $6,320 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $2,431 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| n/a | |||||||||||||||||||||
| 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. MARK H ZAHLER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARK H ZAHLER, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).