| Department File Number : | M201782212 |
| Claim Number : | 1026439-01 |
| Date Submitted : | 2/2/2018 |
| Insurer Information | |||||
| Insurer Name | Coverage Type | ||||
| MEDICAL PROTECTIVE COMPANY (THE) | Primary | ||||
| Insurer FEIN | Professional License Number | ||||
| 35-0506406 | |||||
| Insurer Contact Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Lynn | Louthan | |||
| Street Address | |||||
| 5814 Reed Road | |||||
| City | State | Zip | |||
| Ft Wayne | IN | 46835 | |||
| Phone | Ext | Fax | E-Mail Address | ||
| (260) 486 - 0778 | reportaclaim@medpro.com | ||||
| Insured Information | |||||
| Type | First Name | MI | Last Name | ||
| Individual | Sajana | Allin | |||
| Insurer Type | Street Address of Practice | ||||
| Licensed | 1325 NE 42nd St | ||||
| City | State | Zip Code | County | ||
| Ocala | FL | 34479 | Marion | ||
| Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
| 702977 | $2,000,000 | $4,000,000 | |||
| Profession or Business | Other Profession or Business | ||||
| Dentistry | |||||
| License Number | Specialty Code & Classification | Certification Number | |||
| DN16652 | Dental General Practice - NOC | ||||
| Injured Person Information | |||||
| First Name | MI | Last Name | Date of Birth | ||
| Street Address | Gender | County where Injury Occurred | |||
| F | Marion | ||||
| 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 | ||||
| 10/17/2014 | 6/17/2015 | ||||
| Diagnostic Information | |||||
| Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
| Pressure from wisdom teeth | |||||
| Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
| Extraction of teeth #1,16,17, and 32 | |||||
| Diagnostic Code : | |||||
| Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
| Improper treatment | |||||
| Principal Injury Giving Rise To The Claim | |||||
| Bilateral nerve injury; numbness lower jaw and lip | |||||
| 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 | ||||
| 10/23/2015 | 2015-CA-0003857 | ||||
| County Suit Filed in | Date of Final Disposition | ||||
| Alachua | 5/24/2017 | ||||
| Other Defendants Involved in this Claim | |||||
| Allin Family Dentistry PLLC | |||||
| 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 | |||||
| Financial Information | |||||||||||||||||||||
| Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
| Indemnity Paid by Insurer on behalf of Insured | $85,000 | ||||||||||||||||||||
| Loss Adjust Expense Paid to Defense Counsel | $43,964 | ||||||||||||||||||||
| All Other Loss Adjustment Expense Paid | $23,452 | ||||||||||||||||||||
| Injured Person's Total Non-Economic Loss | $77,000 | ||||||||||||||||||||
| Deductible | $0 | ||||||||||||||||||||
| Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
| Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
| n/a | |||||||||||||||||||||
| Updates | ||||||||||
| Date of Change: | 8/22/2017 9:53:14 AM | |||||||||
| Reason for Change: | ALE UPDATE 8/22/2017 | |||||||||
| ||||||||||
| Date of Change: | 2/2/2018 10:33:38 AM | |||||||||
| Reason for Change: | ALE UPDATE 2/2/2018 | |||||||||
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Does Dr. SAJANA ALLIN, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SAJANA ALLIN, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).