Department File Number : | M201679369 |
Claim Number : | 336238 |
Date Submitted : | 8/6/2016 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
DOCTORS COMPANY, AN INTERINSURANCE EXCHANGE (THE) | Primary | ||||
Insurer FEIN | Professional License Number | ||||
95-3014772 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Kelly | Andrews | |||
Street Address | |||||
12724 Gran Bay Parkway, W., Suite 400 | |||||
City | State | Zip | |||
Jacksonville | FL | 32258 | |||
Phone | Ext | Fax | E-Mail Address | ||
(904) 360 - 3038 | kandrews@thedoctors.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | William | A | Buchholz | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 6937 NW 107 Terrace | ||||
City | State | Zip Code | County | ||
Parkland | FL | 33076 | Broward | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
0951075 | $500,000 | $1,500,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN5645 | Dental General Practice - NOC |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Broward | ||||
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 | Physicians Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
1/27/2014 | 11/20/2015 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient sought treatment for root canal therapy. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Root canal. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged improper performance of root canal. | |||||
Principal Injury Giving Rise To The Claim | |||||
perforation and leakage resulting in re-treatment of root canal. | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 7/21/2016 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Claim or suit abandoned. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
Court Decision | Other | ||||
Other | Dismissed - Case closed due to inactivity. | ||||
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 | $4,950 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $1,443 | ||||||||||||||||||||
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 | |||||||||||||||||||||
Insurance company staff consulted with insured to discuss preventative measures. Patient Safety referral is made if appropriate. |
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. WILLIAM A BUCHHOLZ, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. WILLIAM A BUCHHOLZ, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).