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

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