Department File Number : | M201780825 |
Claim Number : | 1035833 |
Date Submitted : | 1/10/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Matthew | M | Kruszewski | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2753 State Road 580 Ste 108 | ||||
City | State | Zip Code | County | ||
Clearwater | FL | 33761 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
795160 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN21302 | Endodondics |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pinellas | ||||
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 | ||||
Special Procedure Room | |||||
Date of Occurrence | Date Reported to Insurer | ||||
9/2/2015 | 8/24/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Dental | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
apicoetomy on tooth #19` | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
negligent performance of procedure | |||||
Principal Injury Giving Rise To The Claim | |||||
suffers with unrestorable permanent damage | |||||
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 | 1/5/2017 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
Dropped before Action Filed | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
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 | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
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. MATTHEW M KRUSZEWSKI, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MATTHEW M KRUSZEWSKI, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).