| Department File Number : | M201677746 |
| Claim Number : | 2026 |
| Date Submitted : | 3/30/2016 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| AMERICAN ASSOCIATION OF ORTHODONTISTS INS. CO. | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 03-0347914 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Elizabeth | Franklin | |||
| Street Address | |||||
| 401 N. Lindbergh Blvd. | |||||
| City | State | Zip | |||
| St. Louis | MO | 63141 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (314) 292 - 6526 | (314) 993 - 6843 | efranklin@aaortho.org | |||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Matthew | S | Baker | ||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 5911 N. Honore Ave. | ||||
| City | State | Zip Code | County | ||
| Sarasota | FL | 34231 | Manatee | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| PLC09FL00236-04 | $1,000,000 | $3,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN17767 | Orthodontics | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Manatee | ||||
| City | State | Zip Code | |||
| Location where injury occured | Other location where injury occured | ||||
| Other Location | Orthodontic office | ||||
| Name of Institution | Code | ||||
| Location of Institutional Injury | Other Location of Institutional Injury | ||||
| Other | Orthodontic office | ||||
| Date of Occurrence | Date Reported to Insurer | ||||
| 4/13/2009 | 7/9/2012 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Crowding. | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Orthodontic treatment. | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| *NR | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Root resorption developed during orthodontic treatment; possible loss of teeth 8 and 9. | |||||
| 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 | ||||
| 10/29/2012 | 11-003930-CA | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Charlotte | 10/30/2014 | ||||
| Other Defendants Involved in this Claim | |||||
| Kay O'Leary, DDS, PA O'Leary, Kay | |||||
| 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 | |||||
| 12/17/2014 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $62,500 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $104,995 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $47,500 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| Improved monitoring of teeth using radiographs and examinations. | |||||||||||||||||||||
| 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. MATTHEW S BAKER, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. MATTHEW S BAKER, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).