Department File Number :

M200114689

Claim Number :

89-0409

Date Submitted :

1/16/2001

 

Insurer Information

 

Insurer Name

Coverage Type

LEGION INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

23-1892289

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

DAVID

M

EAKIN

Street Address

1515 Wilson Blvd. , Suite 800

City

State

Zip

Arlington

VA

22209

Phone

Ext

Fax

E-Mail Address

(703) 907 - 3800

339

(703) 276 - 9419

David M. Eakin

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

CAROL

 

MIKULKA

Insurer Type

Street Address of Practice

Licensed

1155 LOUISIANA AVE., SUITE 207

City

State

Zip Code

County

WINTER PARK

FL

32789

Orange

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

89 IPRO

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME0050632

Physciatry - Including Child

-

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

 

M

*NR

City

State

Zip Code

 

 

 

Location where injury occured

Other location where injury occured

Hospital Inpatient Facility

 

Name of Institution

Code

LAUREL OAKS HOSPITAL

110015

Location of Institutional Injury

Other Location of Institutional Injury

Patients' Room

 

Date of Occurrence

Date Reported to Insurer

6/9/1989

1/22/1992

 

Diagnostic Information

 

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

Depression

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Continued hospitalization

Diagnostic Code :

296.20

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

N/A

Principal Injury Giving Rise To The Claim

Allegation of improper hospitalization

Severity Of Injury

Emotional Only - Fright, no physical damage

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

1/10/1992

CI92-258

County Suit Filed in

Date of Final Disposition

Orange

11/13/2000

Other Defendants Involved in this Claim

LAUREL OAKS HOSPITAL
BLANKENMEIER, JOHN

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

$18,000

Loss Adjust Expense Paid to Defense Counsel

$89,137

All Other Loss Adjustment Expense Paid

$0

Injured Person's Total Non-Economic Loss

$18,000

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

N/A - Contested claim. Settled for less than expected defense costs

 

Updates

 

No updates found.