| Department File Number : | M201781037 |
| Claim Number : | MM275124 |
| Date Submitted : | 2/2/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EVANSTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2950161 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | CRYSTAL | L | ALSTONBAYTON | ||
| Street Address | |||||
| 4600 COX ROAD | |||||
| City | State | Zip | |||
| GLEN ALLEN | VA | 23060 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (804) 864 - 3731 | (855) 662 - 7535 | CALSTONBAYTON@MARKELCORP.COM | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | BRIAN | FERBER | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5700 LAKE WORTH RD SUITE 301 | ||||
| City | State | Zip Code | County | ||
| GREENACRES | FL | 33463 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MM824898 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16161 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Palm Beach | ||||
| 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 SUITE | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 9/17/2013 | 3/26/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| CLAIMANT PRESENTED WITH TOOTH PAIN; ADVISED TOOTH 14 NEEDED EXTRACTION, WHICH WAS DONE AND BRIDGE PLACED ON 9-9-2013. PT NEEDED CROWN REMOVAL AND A BRIDGE PLACED ALONG WITH HEAVY PLAQUE REMOVAL. NO PAIN AFTER PROCEDURE AND HEAVY PLAQUE REMOVAL. PERM BRIDGE PLACED ON 12/3 CLMT DID NOT RETURN. TEN MONTHS LATER CLMT HAD SEVERE SINUS INFECTION REQUIRING SURGERY DISCOVERED ACRYLIC UNDER CLMTS GUM LINE. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| CLAIMANT PRESENTED WITH TOOTH PAIN; ADVISED TOOTH 14 NEEDED EXTRACTION, WHICH WAS DONE AND BRIDGE PLACED ON 9-9-2013. PT NEEDED CROWN REMOVAL AND A BRIDGE PLACED ALONG WITH HEAVY PLAQUE REMOVAL. NO PAIN AFTER PROCEDURE AND HEAVY PLAQUE REMOVAL. PERM BRIDGE PLACED ON 12/3 CLMT DID NOT RETURN. TEN MONTHS LATER CLMT HAD SEVERE SINUS INFECTION REQUIRING SURGERY DISCOVERED ACRYLIC UNDER CLMTS GUM LINE. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| NO MISDIAGNOSIS. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| CLMT DEVELOPED SINUS INFECTION TEN MONTHS AFTER LAST VISIT WITH INSD. THIS REQUIRED SINUS SURGERY AND ORAL SURGERY. ACRYLIC WAS DISCOVERED UNDER THE GUM LINE OF THE CLMT AND A NEW BRIDGE WAS PLACED TO REPLACE THE BRIDGE DONE BY THE INSD. | |||||
| Severity Of Injury | |||||
| Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| 12/17/2015 | 50-2015-CA-014016 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 1/17/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| JETHWA, DEEPALI N | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Claim or suit abandoned. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 9/8/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $35,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $29,944 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $5,000 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| NONE | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201781018 |
| Claim Number : | MM270858 |
| Date Submitted : | 1/31/2017 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EVANSTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2950161 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | CRYSTAL | L | ALSTONBAYTON | ||
| Street Address | |||||
| 4600 COX ROAD | |||||
| City | State | Zip | |||
| GLEN ALLEN | VA | 23060 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (804) 864 - 3731 | (855) 662 - 7535 | CALSTONBAYTON@MARKELCORP.COM | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | BRIAN | FERBER | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5700 LAKE WORTH ROAD | ||||
| City | State | Zip Code | County | ||
| GREENACRES | FL | 33463 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MM823785 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16161 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | DENTAL EXAM ROOM | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | FERBER DENTAL GROUP | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/1/2012 | 5/5/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| CLAIMANT EXPERIENCED ISSUES WITH RESTORATIONS BREAKING. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| CLAIMANT UNDERWENT EXPLANTATION OF SEVERAL TEETH BY INSD¿S CONTRACTED DENTIST ANNA ROYZMAN. SHE APPARENTLY DREW UP A PLAN FOR IMPLANT PLACEMENT; A PROSTHODONTIST OR ENDODONTIST WITH THE GROUP PLACED OSSEOGRATED IMPLANTS; ROYZMAN WOULD HAVE PERFORMED THE RESTORATIVE DENTISTRY, CONSISTING OF A MAXILLARY IMPLANT SUPPORTED PROSTHESIS AND A BAR-RETAINED MANDIBULAR ARCH PROSTHESIS. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| NO MISDIAGNOSIS. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| DAMAGED DENTAL RESTORATIONS ALLEDGED REQUIRING FURTHER RESTORATION TO PREVENT PROSTHETIC TEETH FROM CRACKING AND TO ALLOW FOR PROSTHETIC HYGIENE. | |||||
| 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 | ||||
| 8/26/2014 | 50-2014-CA-010474 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Palm Beach | 11/30/2016 | ||||
| Other Defendants Involved in this Claim | |||||
| ROYZMAN, ANNA | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| Within 90 days of suit being filed. | |||||
| Final Method of Claim Disposition | |||||
| Settled by parties | |||||
| Court Decision | Other | ||||
| No Court Proceedings. | |||||
| Arbitration | |||||
| Claim not subject to Arbitration. | |||||
| Date of Payment | |||||
| 4/28/2016 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $15,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $54,557 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $15,255 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $5,000 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| NONE | |||||||||||||||||||||
| Updates | |
| No updates found. |
This page is not displaying certain sensitive information.
| Department File Number : | M201573820 |
| Claim Number : | MM270851 |
| Date Submitted : | 3/18/2015 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| EVANSTON INSURANCE COMPANY | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 36-2950161 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Kimberly | C | Stokes | ||
| Street Address | |||||
| 4600 Cox Road | |||||
| City | State | Zip | |||
| Glen Allen | VA | 23060 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (804) 287 - 6965 | kimberly.stokes@markelcorp.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | BRIAN | A | FERBER | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5700 Lake Worth Road | ||||
| City | State | Zip Code | County | ||
| Greenacres | FL | 33463 | Palm Beach | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| MM823785 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16161 | Dentists | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Palm Beach | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Dentist Office | ||||
| Name of Institution | Code | ||||
| N/A | 000000 | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Ferber Dental Group | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/4/2012 | 5/5/2014 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The claimant wanted to correct chipped teeth and missing bridge. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| The claimant received implants at teeth 18 and 19. Claimant alleges implant at 18 was too close to 19 and not deep enough, causing apparent implant failure. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis were made. | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The claimant alleges loss of dental implant, other damages unknown at present, economic damages and pain and suffering. | |||||
| 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 | 7/29/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Stage of Legal System at which Settlement was Reached or Award Made | |||||
| After arbitration is initiated or prior to suit being filed. | |||||
| 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 | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
| Deductible | $9,113 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| none | |||||||||||||||||||||
| 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. BRIAN FERBER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. BRIAN FERBER, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).