Department File Number :

M200117262

Claim Number :

21-00-00911

Date Submitted :

8/20/2001

 

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

LORI

 

SHRINER

Insurer Type

Street Address of Practice

Licensed

1321 WEST FLETCHER AVENUE, #B

City

State

Zip Code

County

TAMPA

FL

33612

Hillsborough

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

CMP0007694

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

62861

Physciatry - Including Child

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

 

M

*NR

City

State

Zip Code

 

 

 

Location where injury occured

Other location where injury occured

Patient's Home

 

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

2/1/1998

1/6/2000

 

Diagnostic Information

 

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

Counseling

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Medical director of facility

Diagnostic Code :

 

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

n/a

Principal Injury Giving Rise To The Claim

Suicide

Severity Of Injury

Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

5/19/2000

00-03814

County Suit Filed in

Date of Final Disposition

Hillsborough

7/27/2001

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

$21,003

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.