| Department File Number : | M201677204 |
| Claim Number : | 59197 |
| Date Submitted : | 2/17/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NCMIC INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 42-0635534 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Michelle | R | Gould | ||
| Street Address | |||||
| 14001 University Avenue | |||||
| City | State | Zip | |||
| Clive | IA | 50325 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (515) 313 - 4558 | (515) 313 - 4471 | mgould@ncmic.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Remal | Patel | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2091 Collier Parkway | ||||
| City | State | Zip Code | County | ||
| ST PETERSBURG | FL | 34639 | Pasco | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DPL016777 | $1,100,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN19054 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Pasco | ||||
| 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 | ||||
| Patients' Room | |||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 3/18/2013 | 3/2/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Cosmetic veneers ineffective | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| ineffective veneers | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| cosmetic / veneers | |||||
| Principal Injury Giving Rise To The Claim | |||||
| cosmetic | |||||
| Severity Of Injury | |||||
| Emotional Only - Fright, no physical damage | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 1/22/2014 | 13/cc-024473 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Hillsborough | 4/14/2015 | ||||
| Other Defendants Involved in this Claim | |||||
| DENTAL HEALTH GROUP | |||||
| 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 | |||||
| No Payment Made | |||||
| 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 | $875 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| Updates | |
| No updates found. |
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Does Dr. REMAL PATEL, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. REMAL PATEL, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).