Department File Number :

M200010664

Claim Number :

96-0371-10S

Date Submitted :

4/4/2000

 

Insurer Information

 

Insurer Name

Coverage Type

LEGION INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

23-1892289

 

Insurer Contact Information

Type

Entity Name

Entity

PROFESSIONAL RISK MANAGEMENT SERVICES

Street Address

1515 Wilson Blvd., Suite 800

City

State

Zip

Arlington

VA

22309

Phone

Ext

Fax

E-Mail Address

(703) 907 - 3800

 

(703) 276 - 9419

 

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

CHRISTINA

 

SMITH

Insurer Type

Street Address of Practice

Licensed

901 Progresson Drive, Suite U8

City

State

Zip Code

County

Ft. Lauderdale

FL

33304

Broward

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

GL3000001

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

006790

Physciatry - Including Child

84249

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

 

 

 

Injured Person Information

 

First Name

MI

Last Name

Date of Birth

 

 

 

 

Street Address

Gender

County where Injury Occurred

 

F

*NR

City

State

Zip Code

 

 

 

Location where injury occured

Other location where injury occured

Hospital Inpatient Facility

 

Name of Institution

Code

FLORIDA MEDICAL CENTER

100210

Location of Institutional Injury

Other Location of Institutional Injury

Patients' Room

 

Date of Occurrence

Date Reported to Insurer

4/19/1997

4/3/1998

 

Diagnostic Information

 

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition

Major Depression and severe psychosis

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

N/A

Diagnostic Code :

 

Misdiagnosis Made, If Any, Of Patient's Actual Condition

Alleged failure to diagnose and treat respiratory difficulties

Principal Injury Giving Rise To The Claim

Patient's Death

Severity Of Injury

Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

11/23/1998

98-018775 CA 14

County Suit Filed in

Date of Final Disposition

Broward

10/25/1999

Other Defendants Involved in this Claim

SWARTZ, AARON
KALIDINDI, TAMMIRAJU
FRANKEL, JOE
LAMBERT, ALBERT

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

$150,000

Loss Adjust Expense Paid to Defense Counsel

$68,498

All Other Loss Adjustment Expense Paid

$0

Injured Person's Total Non-Economic Loss

$0

Deductible

$0

Injured Person's Total Economic Loss

 

Incurred to Date

Anticipated

Medical Expense

$0

$0

Wage Loss

$0

$0

Other Expenses

$0

$0

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

N/A

 

Updates

 

No updates found.