Department File Number : | M201781824 |
Claim Number : | 2192219 |
Date Submitted : | 4/14/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
THE CINCINNATI INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
31-0542366 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Heather | N | Hartman | ||
Street Address | |||||
6200 South Gilmore Road | |||||
City | State | Zip | |||
Fairfield | OH | 45014 | |||
Phone | Ext | Fax | E-Mail Address | ||
(513) 603 - 5846 | (513) 371 - 7028 | Heather_Hartman@CINFIN.COm |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Noel | L | Spurlock | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 4041 Hwy 90 | ||||
City | State | Zip Code | County | ||
Pace | FL | 32571 | Santa Rosa | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
CPP 1083179 | $1,000,000 | $2,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN6463 | Dental General Practice - NOC |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Santa Rosa | ||||
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 | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/23/2012 | 4/2/2014 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
While insd extracting clmt's 3rd molar, a burr tool bit broke off in clmt's mouth. Clmt is alleging insd insd breached the ordinary standard of care surrounding the procedure. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
While insd extracting clmt's 3rd molar, a burr tool bit broke off in clmt's mouth. Clmt is alleging insd insd breached the ordinary standard of care surrounding the procedure. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
While insd extracting clmt's 3rd molar, a burr tool bit broke off in clmt's mouth. Clmt is alleging insd insd breached the ordinary standard of care surrounding the procedure. | |||||
Severity Of Injury | |||||
Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
8/18/2014 | 2014-CA 000768 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Santa Rosa | 4/13/2017 | ||||
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 | |||||
4/13/2017 |
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 | $20,080 | ||||||||||||||||||||
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 | |||||||||||||||||||||
None given |
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. NOEL L SPURLOCK, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. NOEL L SPURLOCK, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).