Department File Number : | M202091282 |
Claim Number : | 6032724 |
Date Submitted : | 1/29/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OMS NATIONAL INSURANCE COMPANY, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3571664 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | FLORENCE | R | MARAFATSOS | ||
Street Address | |||||
425 N. Martingale Road | |||||
City | State | Zip | |||
Schaumburg | IL | 60173 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 522 - 6675 | 8466 | (847) 653 - 8486 | ERICA.AMES@FORTRESSINS.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Spiro | J | Pantzoulas | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 885 Spring Park Loop | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
2000614 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN17517 | Oral and Maxillofacial Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
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 | ||||
10/8/2015 | 5/22/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Plaintiff alleges lingual nerve injury following the extraction. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The insured extracted tooth #17. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient was referred for extraction of symptomatic tooth #17. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
2/7/2018 | 2018-CA-001345-O | ||||
County Suit Filed in | Date of Final Disposition | ||||
Orange | 1/3/2020 | ||||
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 | |||||
Award for plaintiff. | |||||
Date of Payment | |||||
1/21/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $125,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $42,888 | ||||||||||||||||||||
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 | |||||||||||||||||||||
documentation |
Updates | |
No updates found. |
Department File Number : | M201884362 |
Claim Number : | 6032724 |
Date Submitted : | 2/19/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OMS NATIONAL INSURANCE COMPANY, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3571664 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Florence | R | Marafatsos | ||
Street Address | |||||
6133 N River Road Ste 650 | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 522 - 6675 | 8466 | (847) 653 - 8486 | florence.marafatsos@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Spiro | J | Pantzoulas | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 885 Spring Park Loop | ||||
City | State | Zip Code | County | ||
Celebration | FL | 34747 | Osceola | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
2000614 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN17517 | Oral and Maxillofacial Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Osceola | ||||
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 | Dentist Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/8/2015 | 5/22/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Painful horizontally impacted molar | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Extraction of tooth #17 | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Left sided paresthesia. | |||||
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 | 1/29/2018 | ||||
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 | |||||
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? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $10,881 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $10,881 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Unknown |
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. SPIRO J PANTZOULAS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SPIRO J PANTZOULAS, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).