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).