| Department File Number : | M201676933 |
| Claim Number : | 310655 |
| Date Submitted : | 1/27/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 95-3014772 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | AUDRA | M | FLOYD | ||
| Street Address | |||||
| 13450 WEST SUNRISE BLVD | |||||
| City | State | Zip | |||
| SUNRISE | FL | 33323 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (877) 320 - 0748 | 3111 | (866) 636 - 5421 | afloyd@thedoctors.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Mark | W | Fedele | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 500 NW Dixie Highway | ||||
| City | State | Zip Code | County | ||
| Stuart | FL | 34994 | Martin | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 0960148 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN12691 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | St. Lucie | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Patient's Home | |||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Physician's Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/7/2010 | 9/25/2013 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Tongue cancer. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| None. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| None. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Tongue cancer. | |||||
| Severity Of Injury | |||||
| Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/2/2014 | 14-41-CA | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Martin | 1/26/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| McKinney, DMD, Colin | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| No Payment Made | |||||
| Court Decision | Other | ||||
| Other | Dismissed | ||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | No | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $0 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $61,000 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Insured has consulted with defense counsel and claims personnel. | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. MARK W FEDELE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARK W FEDELE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).