Department File Number : | M201783184 |
Claim Number : | 6031417 |
Date Submitted : | 9/22/2017 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OMS NATIONAL INSURANCE COMPANY, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3571664 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Janet | L | Meyer | ||
Street Address | |||||
6133 North River Road, Suite 650 | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 522 - 6670 | (847) 653 - 8486 | janet.meyer@fortressins.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Benjamin | First | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 6906 Madison St. Ste. 2 | ||||
City | State | Zip Code | County | ||
New Port Richey | FL | 34652 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
24507 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN15348 | Dentists - Engaged in oral surgery or operative dentistry on patients rendered unconscious through the administering of any anesthesia or analgesia |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Pasco | ||||
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 | ||||
8/14/2012 | 6/27/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient referred to the insured for evaluation of radiolucency between teeth #s 3 & 5, noting that tooth #4 was displaced bucally and mesially and that the gum had a tumor like appearance. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Insured performed a biopsy, which revealed an odontogenic myxoma. Insured reviewed the results with the patient & her guardian advising that a second debridement or bone graft may be needed in the future. A re-evaluation was planned for 6 months. The 6 month followup appointment was cancelled & patient did not return to the insured in followup for 16 months. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged negligence in failing to diagnose an odontogenic myxoma oral tumor resulting in a right maxillectomy and extraction of teeth #s 1 through 9. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
5/26/2016 | 2016-CA-887 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 9/22/2017 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
8/15/2017 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $150,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $59,235 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $6,504 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
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Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
Unknown |
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. BENJAMIN FIRST, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BENJAMIN FIRST, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).