M200013787

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	GUILLERMO			BLANCO
Insurer Type		Street Address of Practice
Licensed		1990 NE 163 STREET, #202
City		State	Zip Code	County
NORTH MIAMI BEACH		FL	33162	Dade
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
CMP0005240		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
44402		Neurology - Including Child - No Surgery		00000

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
7/1/1996		11/16/1998

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Depression
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Prescriptions
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
n/a
Principal Injury Giving Rise To The Claim
Alleged Dyskinesia syndrome
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
1/1/1997	97-21548 CA 08
County Suit Filed in	Date of Final Disposition
Dade	10/12/2000
Other Defendants Involved in this Claim
INSTITUTE FOR FAMILY THERAPY SANTEIRO, JOSE
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

$66,965

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

$250,000

Deductible

Injured Person's Total Economic Loss

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

In house peer review

Updates

No updates found.