Department File Number :	M200221989
Claim Number :	253250
Date Submitted :	10/9/2002

Insurer Information
Insurer Name				Coverage Type
MEDICAL PROTECTIVE COMPANY (THE)				Primary
Insurer FEIN		Professional License Number
35-0506406
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	AMY		M	THOMAS-BENTZ
Street Address
5814 Reed Road
City				State	Zip
Fort Wayne				IN	46835
Phone	Ext	Fax	E-Mail Address
(260) 485 - 9622	6780	(260) 486 - 0808	amy.thomas@gemedicalprotective.com

Insured Information
Type	First Name		MI	Last Name
Individual	DENNIS		R	BRIGHTWELL
Insurer Type		Street Address of Practice
Licensed		970 MC HENRY AVE
City		State	Zip Code	County
CRYSTAL LAKE		IL	60014-7449	Out of state
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
608650		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
0059388				0

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
Other Outpatient Facility
Name of Institution		Code
Location of Institutional Injury		Other Location of Institutional Injury
Date of Occurrence		Date Reported to Insurer
2/1/1996		10/26/1998

Diagnostic Information

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

DEPRESSION DUE TO FAILED BACK SYNDROME

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

PRESCRIPTION OF WELLBUTRIN AND ALPRAZOLAM

Diagnostic Code :

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

IMPROPER TREATMENT AND DIAGNOSIS

Principal Injury Giving Rise To The Claim

DEATH DUE TO 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
5/26/1999	199931203CICI
County Suit Filed in	Date of Final Disposition
Volusia	7/11/2002
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

$100,000

Loss Adjust Expense Paid to Defense Counsel

$33,247

All Other Loss Adjustment Expense Paid

$8,709

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

N/A

Updates

No updates found.