Department File Number :	M200012269
Claim Number :	21-99-00730
Date Submitted :	8/3/2000

Insurer Information
Insurer Name				Coverage Type
CLARENDON NATIONAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
52-0266645
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	WILLIAM		J	THOMPSON
Street Address
P.O. Box 12200
City				State	Zip
Tallahassee				FL	32302
Phone	Ext	Fax	E-Mail Address
(850) 386 - 1115	4160	(850) 385 - 1657

Insured Information
Type	First Name		MI	Last Name
Individual	ADORACION			SOTOMAYOR
Insurer Type		Street Address of Practice
Licensed		365 OLIVER ST W
City		State	Zip Code	County
BALDWIN		FL	32234-1709	Duval
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
CMP0005768		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
0028715		Family Physicians or General Practitioners - No Surgery		00000

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
Physician's Office
Name of Institution		Code
Location of Institutional Injury		Other Location of Institutional Injury
Date of Occurrence		Date Reported to Insurer
5/1/1997		4/21/1999

Diagnostic Information

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

Myalgia, seizure disorder, anxiety reaction, hypertension, arthritis

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Prescribed Trental, Xanax, Primeval, Naprosyn, Tylenol, Ativan, refers to neurologist

Diagnostic Code :

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

n/a

Principal Injury Giving Rise To The Claim

bilateral strokes

Severity Of Injury

Permanent: Minor - Loss of fingers, loss or damage to organs. Includes non-disabling injuries.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information
Date of Suit	Circuit Court Case Number
8/3/1999	99-04870 CA
County Suit Filed in	Date of Final Disposition
Duval	6/27/2000
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

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$250,000

Loss Adjust Expense Paid to Defense Counsel

$31,285

All Other Loss Adjustment Expense Paid

$0

Injured Person's Total Non-Economic Loss

$250,000

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

In house peer review

Updates

No updates found.