Department File Number : | M201472375 |
Claim Number : | 2012-112400 |
Date Submitted : | 10/17/2014 |
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 | Mohammad | Shuayb | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 229 Mariner Blvd | ||||
City | State | Zip Code | County | ||
Spring Hill | FL | 34609 | Hernando | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
DNU 003210942 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN15081 | Dental General Practice - NOC | 80211 |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hernando | ||||
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 | ||||
5/21/2012 | 10/18/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient presented with pain in tooth #32 | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Insured extracted tooth #32 | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
No misdiagnosis | |||||
Principal Injury Giving Rise To The Claim | |||||
Patient alleged infection post extraction and incorrect antibiotics. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/27/2013 | CA 13 492 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Hernando | 8/5/2014 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
8/1/2014 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $175,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $21,739 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,467 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $102,000 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
No safety managment steps taken. |
Updates | |
No updates found. |
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Does Dr. MOHAMMAD SHUAYB, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MOHAMMAD SHUAYB, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).