M200114692

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	CHARLES			DACK, MD
Insurer Type		Street Address of Practice
Licensed		213 KERNEYWOOD STREET
City		State	Zip Code	County
LAKELAND		FL	33803	Polk
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PL2-259977		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0036598		Physciatry - Including Child		-

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
LAKELAND REGIONAL MEDICAL CENTER		100157
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
12/25/1996		12/18/1998

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Major Depression
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Psychiatric evaluation and treatment
Diagnostic Code :	296.33
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Alleged failure to diagnose CVA
Principal Injury Giving Rise To The Claim
CVA
Severity Of Injury
Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Legal Information

Date of Suit	Circuit Court Case Number
3/30/1999	G98-1249
County Suit Filed in	Date of Final Disposition
Polk	8/10/2000
Other Defendants Involved in this Claim
LAKELAND REGIONAL MEDICAL CENTER
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

$275,000

Loss Adjust Expense Paid to Defense Counsel

$120,376

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

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

N/A

Updates

No updates found.