| Department File Number : | M201987728 |
| Claim Number : | 2018-127000 |
| Date Submitted : | 1/28/2019 |
| 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 | FREDERICK | BANKS | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 476 Highway A1a. Ste B | ||||
| City | State | Zip Code | County | ||
| Satellite Beach | FL | 32937 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU060253039 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN18589 | Dentists - NOC classification. | 80211 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Brevard | ||||
| 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 | ||||
| 6/1/2017 | 6/14/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Loose upper anterior bridge, missing several teeth, no occlusion, pre existing fillings. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Upper anterior implant supported partial, lower anterior restorations | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| no misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| No specific allegations. Insured passed away in the middle of treatment. The patient subsequently had a maxillary denture placed and she will be replacing a partial. | |||||
| 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 | 1/17/2019 | ||||
| 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 | |||||
| 12/21/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $9,677 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $628 | ||||||||||||||||||||
| 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. |
| Department File Number : | M201988859 |
| Claim Number : | 2018-126975 |
| Date Submitted : | 5/21/2019 |
| 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 | FREDERICK | BANKS | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 476 Highwat A1A | ||||
| City | State | Zip Code | County | ||
| Satellite Beach | FL | 32937 | Brevard | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU060253039 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN18589 | Dental General Practice - NOC | 80211 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Brevard | ||||
| 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 | ||||
| 6/1/2016 | 6/12/2018 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Patient needed implants | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Placement of four implants. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| No misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Insured passed away in the middle of treatment. Implants placed were removed and replaced with an upper denture as well as a partial lower denture. No liability proven against Dr Bates | |||||
| Severity Of Injury | |||||
| Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. | |||||
| Legal Information | |||||
| Date of Suit | Circuit Court Case Number | ||||
| *NR | |||||
| County Suit Filed in | Date of Final Disposition | ||||
| *NR | 5/21/2019 | ||||
| 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 | |||||
| 5/2/2019 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $9,501 | ||||||||||||||||||||
| 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. |
| Department File Number : | M201885106 |
| Claim Number : | 2018-126050 |
| Date Submitted : | 4/19/2018 |
| 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 | FREDERICK | BANKS | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 476 Highway A1A | ||||
| City | State | Zip Code | County | ||
| Satellite Beach | FL | 32937 | Lake | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| DNU060253039 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN18589 | Dental General Practice - NOC | 80211 | |||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| M | Lake | ||||
| 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 | ||||
| 1/1/2014 | 12/5/2017 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| The insured, who is deceased, had previously seated a bridge that came undone. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Subsequent DDS was unable to reseat the bridge. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| no misdiagnosis | |||||
| Principal Injury Giving Rise To The Claim | |||||
| The patient needed a new bridge | |||||
| 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 | 3/28/2018 | ||||
| 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 | |||||
| 3/28/2018 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $4,200 | ||||||||||||||||||||
| 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. FREDERICK BANKS, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. FREDERICK BANKS, MD has at least 3 medical malpractice case(s), lawsuit(s), or complaint(s).