| Department File Number : | M201573146 |
| Claim Number : | 2014-116024 |
| Date Submitted : | 1/8/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-0687550 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Connie | L | Peters | ||
| Street Address | |||||
| PO Box 52810 | |||||
| City | State | Zip | |||
| Bellevue | WA | 98015 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (425) 636 - 1000 | 1012 | (916) 781 - 5795 | cpeters@intercareins.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yolanda | Cintron | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2021 E Commercial Blvd., Ste 208 | ||||
| City | State | Zip Code | County | ||
| Fort Lauderdale | FL | 33308 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU 060249400 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN13826 | Dental General Practice - NOC | 80211 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | 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 | Dental Treatment Room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 10/10/2011 | 2/4/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| PAtient presented for exam on teeth 6.7 & 13 | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Root canal on #13 | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Patient alleged improper root canal on tooth #13 requiring retreatment.. | |||||
| Severity Of Injury | |||||
| Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 10/16/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Settlement Reached Prior to Pre-Suit Period | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 10/16/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $25,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $500 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| No safety managment steps taken. | |||||||||||||||||||||
| 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.
| Department File Number : | M201576293 |
| Claim Number : | 2015-119794 |
| Date Submitted : | 11/11/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURGH, PA | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 25-0687550 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Connie | L | Peters | ||
| Street Address | |||||
| PO Box 52810 | |||||
| City | State | Zip | |||
| Bellevue | WA | 98015 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (425) 636 - 1000 | 1012 | (916) 781 - 5795 | cpeters@intercareins.com | ||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Yolanda | Cintron | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 2021 E Commercial Blvd, #208 | ||||
| City | State | Zip Code | County | ||
| Fort Lauderdale | FL | 33308 | Broward | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU 060249400 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN13826 | Dental General Practice - NOC | 80211 | |||
| 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 | Dental treatment room | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/15/2015 | 6/19/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient needed treament on teeth 30, 31 and 27 | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Insured placed crowns on 30 and 31. Placed a veneer on 27. | |||||
| Diagnostic Code : | UK | ||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Alleged numbness from the anesthesia injection | |||||
| Severity Of Injury | |||||
| Emotional Only - Fright, no physical damage | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 11/10/2015 | ||||
| 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 | ||||
| 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 | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $575 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| No safety management steps taken | |||||||||||||||||||||
| 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. YOLANDA CINTRON, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. YOLANDA CINTRON, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).