Department File Number : | M201576431 |
Claim Number : | FP4303901 |
Date Submitted : | 12/1/2015 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FIRST PROFESSIONALS INSURANCE COMPANY, INC | Primary | ||||
Insurer FEIN | Professional License Number | ||||
59-6614702 | |||||
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 | Ana | M | Bush | ||
Insurer Type | Street Address of Practice | ||||
Licensed | 24632 State Road, #54 | ||||
City | State | Zip Code | County | ||
Lutz | FL | 33559 | Hillsborough | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
FP-IN026805 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN14833 | Dentists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Hillsborough | ||||
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 | Dentist Office | ||||
Date of Occurrence | Date Reported to Insurer | ||||
3/31/2011 | 4/30/2012 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Leakage from a large composite filling on tooth # 14. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Preparation and placement of a permanent crown on tooth # 14. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
Alleged failure to evaluate need for root canal therapy on tooth #14 before the permanent crown was placed. | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged need for bilateral temporary mandibular joint microscopic arthroplasty physical therapy and development migraine headache and neck pain. | |||||
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 | ||||
7/8/2013 | 13-CA-003906 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 11/13/2015 | ||||
Other Defendants Involved in this Claim | |||||
Perfect Smile Dental Studio | |||||
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 | |||||
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $370,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $61,383 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $41,144 | ||||||||||||||||||||
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. |
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Does Dr. ANA M BUSH, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. ANA M BUSH, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).