| Department File Number : | M201885307 |
| Claim Number : | 162036 |
| Date Submitted : | 5/15/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| NORCAL MUTUAL INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 94-2301054 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Richard | Petersen | |||
| Street Address | |||||
| 4651 Salisbury Rd. #410 | |||||
| City | State | Zip | |||
| Jacksonville | FL | 32256 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (904) 309 - 8142 | (904) 394 - 7134 | rpetersen@norcal-group.com | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Amir | Boules | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1457 Oakfield Drive | ||||
| City | State | Zip Code | County | ||
| Brandon | FL | 33511 | Pinellas | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 725219E | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN21457 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Pinellas | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Dentist Office | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Dentist Office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/30/2016 | 3/8/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Mr. Clemons sought an initial consultation on 08/09/16 as he required dentures due to significant bone loss and years of not taking care of his teeth. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Mr. Clemons sought an initial consultation on 08/09/16 as he required dentures due to significant bone loss and years of not taking care of his teeth. Dr. Boules advised the patient that he would not recommend a full/full extraction (full extraction on the top and full extraction on the bottom). Rather, he recommended to do the extractions in portions by first undergoing an upper removal, and then coming back at a later time and do the lower removal. Mr. Clemons raised the point that he would rather get it done all at one time; however, Dr. Boules informed him that it is very difficult to transition to dentures on both the top and bottom, and again recommended the partial. On 09/09/16, the plan changed when Mr. Clemons treated with a different dentist from his office whereupon the chart was changed to a full/full extraction based on the patient's request. Dr. Boules relied on this note and assumed that the decision was made to change the treatment plan from full/partial to full/full. On a follow-up visit, on September 30, 2016, Dr. Boules performed the full/full. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Mr. Clemons sought an initial consultation on 08/09/16 as he required dentures due to significant bone loss and years of not taking care of his teeth. | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/22/2017 | 17-003955CI | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Pinellas | 5/15/2018 | ||||
| Other Defendants Involved in this Claim | |||||
| Coast Dental PA | |||||
| 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 | ||||
| Other | Settled between parties | ||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 4/26/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $20,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| 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 | |||||||||||||||||||||
| The facts of the claim were discussed with Risk Management and the insured-practitioner. | |||||||||||||||||||||
| 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. AMIR BOULES, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. AMIR BOULES, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).