Department File Number :

M200218989

Claim Number :

99M16397

Date Submitted :

2/1/2002

 

Insurer Information

 

Insurer Name

Coverage Type

FRONTIER INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

13-2559805

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

SHARON

 

LOCH

Street Address

195 Lake Louise Marie Road

City

State

Zip

Rock Hill

NY

12775

Phone

Ext

Fax

E-Mail Address

(914) 796 - 2300

5474

(914) 796 - 1801

 

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

HOWARD

A

GOLDMAN

Insurer Type

Street Address of Practice

Licensed

PO BOX 1200

City

State

Zip Code

County

TAMPA

FL

33601-1200

Hillsborough

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

WM0009585

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME0032737

Physciatry - Including Child

80249

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

MANATEE MEMORIAL HOSPITAL

100035

Location of Institutional Injury

Other Location of Institutional Injury

Patients' Room

 

Date of Occurrence

Date Reported to Insurer

4/15/1998

4/22/1999

 

Diagnostic Information

 

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

Improper management of medication regime caused death

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Improper performance of medication regime caused death

Diagnostic Code :

789.1

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

improper management of medication regime caused death

Principal Injury Giving Rise To The Claim

death

Severity Of Injury

Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

 

*NR

County Suit Filed in

Date of Final Disposition

*NR

12/21/2001

Other Defendants Involved in this Claim

MANATEE MEMORIAL HOSPITAL

Stage of Legal System at which Settlement was Reached or Award Made

Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed).

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?

No

Indemnity Paid by Insurer on behalf of Insured

$0

Loss Adjust Expense Paid to Defense Counsel

$8,626

All Other Loss Adjustment Expense Paid

$4,499

Injured Person's Total Non-Economic Loss

$0

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

Insured consulted with legal counsel, claims personnel and medical experts regarding this matter.

 

Updates

 

No updates found.