M200221569

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 Rd
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	JEFFREY			SAMUELS
Insurer Type		Street Address of Practice
Licensed		201 EAST SAMPLE ROAD
City		State	Zip Code	County
POMPANO BEACH		FL	33064	Broward
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
CM0501799		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
G0132		Internal Medicine - No Surgery		84257

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
NORTH BROWARD MEDICAL CENTER		100086
Location of Institutional Injury		Other Location of Institutional Injury
Operating Suite
Date of Occurrence		Date Reported to Insurer
6/5/1995		8/4/1997

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Failure to diagnose compartment syndrome in lower extremity.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Failure to diagnose compartment syndrome in lower extremity.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
Failure to diagnose compartment syndrome in lower extremity.
Principal Injury Giving Rise To The Claim
Failure to diagnose compartment syndrome in lower extremity.
Severity Of Injury
Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Legal Information

Date of Suit	Circuit Court Case Number
11/10/1997	97017402
County Suit Filed in	Date of Final Disposition
Broward	3/26/2001
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

$75,000

Loss Adjust Expense Paid to Defense Counsel

$56,996

All Other Loss Adjustment Expense Paid

$47,353

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

The insured has consulted with defense council and medical experts and claims personel regarding this matter.

Updates

No updates found.