| Department File Number : | M201885595 |
| Claim Number : | 2017-124659 |
| Date Submitted : | 6/13/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-0687550 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Connie | L | Peters | ||
| Street Address | |||||
| PO Box 52810 | |||||
| City | State | Zip | |||
| Bellevue | WA | 98015 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (425) 636 - 1000 | 1012 | (916) 781 - 5795 | cpeters@intercareins.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Marta | L | Nieto | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2710 SW 87th Ave | ||||
| City | State | Zip Code | County | ||
| Miami | FL | 33165 | Dade | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU083946311 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN13137 | Dental General Practice - NOC | 80211 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | 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 | ||||
| Other | Dental treatment room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 11/18/2015 | 8/11/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient presented for implants at #18 and #19. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Practitioner placed implants at #18 and #19. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Implant #18 not integrating so it was removed and patient upset. | |||||
| Severity Of Injury | |||||
| Emotional Only - Fright, no physical damage | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 5/11/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Settlement Reached Prior to Pre-Suit Period | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 5/8/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $24,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $4,634 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $24,500 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| No safety management steps taken | |||||||||||||||||||||
| 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. MARTA L NIETO, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MARTA L NIETO, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).