Department File Number : | M202093126 |
Claim Number : | 6031862 |
Date Submitted : | 7/31/2020 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OMS NATIONAL INSURANCE COMPANY, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3571664 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | FLORENCE | R | MARAFATSOS | ||
Street Address | |||||
425 N. Martingale Road | |||||
City | State | Zip | |||
Schaumburg | IL | 60173 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 522 - 6675 | 8466 | (847) 653 - 8486 | ERICA.AMES@FORTRESSINS.COM |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sascha | Schubert | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 5420 Land O'Lakes Blvd., Suite 103 | ||||
City | State | Zip Code | County | ||
Land O'Lakes | FL | 34639 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
2001461 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN17021 | Oral and Maxillofacial Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pasco | ||||
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 | ||||
1/17/2016 | 10/6/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Plaintiff presented for the extraction of his third molars under IV sedation. | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
The insured extracted teeth #s 1, 16, 17 and 32. | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff alleges that the insured failed to protect the lingual plate and nerve during the extraction of tooth #17 resulting in a lingual nerve injury. | |||||
Severity Of Injury | |||||
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/26/2018 | 71272416 | ||||
County Suit Filed in | Date of Final Disposition | ||||
Pasco | 7/13/2020 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
7/28/2020 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $55,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $133,033 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
documentation |
Updates | |
No updates found. |
Department File Number : | M201885289 |
Claim Number : | 6031862 |
Date Submitted : | 5/11/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
OMS NATIONAL INSURANCE COMPANY, RISK RETENTION GROUP | Primary | ||||
Insurer FEIN | Professional License Number | ||||
36-3571664 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Florence | R | Marafatsos | ||
Street Address | |||||
6133 N River Road Ste 650 | |||||
City | State | Zip | |||
Rosemont | IL | 60018 | |||
Phone | Ext | Fax | E-Mail Address | ||
(800) 522 - 6675 | 8466 | (847) 653 - 8486 | florence.marafatsos@omsnic.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Sascha | Schubert | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 5420 Land O Lakes Blvd | ||||
City | State | Zip Code | County | ||
Land O'Lakes | FL | 34639 | Pasco | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
2001461 | $2,000,000 | $6,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Dentistry | |||||
License Number | Specialty Code & Classification | Certification Number | |||
DN17021 | Oral and Maxillofacial Surgery |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Pasco | ||||
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 | ||||
8/17/2016 | 10/6/2016 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Painful third molars | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Extraction of tooth #17 | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Alleged lingual nerve dysethesia, dysgeusia and paresethesia following extraction | |||||
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 | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 4/10/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is 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 | $10,459 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
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 | |||||||||||||||||||||
unknown |
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. SASCHA SCHUBERT, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. SASCHA SCHUBERT, MD has at least 2 medical malpractice case(s), lawsuit(s), or complaint(s).