Department File Number :

M200221569

Claim Number :

97M09318

Date Submitted :

9/9/2002

 

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 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

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

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.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

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

$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

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

 

Updates

 

No updates found.