Department File Number : | M201884437 |
Claim Number : | 1035912-01 |
Date Submitted : | 8/27/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
35-0506406 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Lynn | Louthan | |||
Street Address | |||||
5814 Reed Road | |||||
City | State | Zip | |||
Ft Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 486 - 0778 | reportaclaim@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Terrance | R | Soule | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 2390 W Old US Highway 441 #2 | ||||
City | State | Zip Code | County | ||
Mount Dora | FL | 32757 | Lake | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
731814 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN18489 | Dentists - NOC classification. |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Lake | ||||
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 | ||||
11/25/2015 | 8/25/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Presented for extraction of left lower molar and implant | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Extraction and immediate implant | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Medical negligence | |||||
Principal Injury Giving Rise To The Claim | |||||
Nerve damage | |||||
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 | ||||
1/19/2017 | 2017-CA-122-B | ||||
County Suit Filed in | Date of Final Disposition | ||||
Marion | 2/22/2018 | ||||
Other Defendants Involved in this Claim | |||||
First Choice Dentistry Management Services LLC dba First Cho First Choice Dentristry PLLC dba First Choice Dentistry | |||||
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 | |||||
2/22/2018 |
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 | $21,081 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $4,749 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $124,078 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
Updates | ||||||||||
Date of Change: | 8/27/2018 11:08:13 AM | |||||||||
Reason for Change: | ALE UPDATE | |||||||||
|
This page is not displaying certain sensitive information.
Does Dr. TERRANCE R SOULE, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. TERRANCE R SOULE, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).