Department File Number : | M201575588 |
Claim Number : | 7010601 |
Date Submitted : | 8/21/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FORTRESS INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-4159841 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Janet | L | Meyer | ||
Street Address | |||||
6133 North River Road, Suite 650 | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(847) 653 - 8823 | (847) 653 - 8485 | janet.meyer@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Tejashree | S | Karkare | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 10700 Johnson Blvd., Ste. 4 | ||||
City | State | Zip Code | County | ||
Seminole | FL | 33772 | Pinellas | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
3002279 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN15266 | Dentists |
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 | ||||
Date of Occurrence | Date Reported to Insurer | ||||
10/31/2012 | 7/9/2013 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
The patient presented for new patient exam. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The insured performed a new patient exam including panorex and propsed a treatment plan. The insured then proceeded with the agreed treatment plan which included build up and crowns for teeth #'s 3 & 7, crowns at teeth #'s 8 through 10, 12 and 13 and a filling at tooth #11. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
The patient alleged the insured provided poor dental care which resulted in the loss of three teeth. | |||||
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 | ||||
7/1/2015 | 29193084 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pinellas | 7/30/2015 | ||||
Other Defendants Involved in this Claim | |||||
Coast Dental Services, LLLC | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within 90 days of suit being filed. | |||||
Final Method of Claim Disposition | |||||
Settled by parties | |||||
Court Decision | Other | ||||
No Court Proceedings. | |||||
Arbitration | |||||
Claim not subject to Arbitration. | |||||
Date of Payment | |||||
8/11/2015 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $23,500 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $15,989 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $105 | ||||||||||||||||||||
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. TEJASHREE S KARKARE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. TEJASHREE S KARKARE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).