M200326888

Insurer Information

Insurer Name				Coverage Type
NATIONAL UNION FIRE INSURANCE CO. OF PITTSBURG, PA				Primary
Insurer FEIN		Professional License Number
25-0687550
Insurer Contact Information
Type		Entity Name
Entity		PROFESSIONAL RISK MANAGEMENT SERVICES, INC.
Street Address
1515 Wilson Blvd Suite 800
City				State	Zip
Arlington				VA	22209
Phone	Ext	Fax	E-Mail Address
(703) 907 - 3800	328	(703) 276 - 9494	bates@prms.com

Insured Information

Type	First Name		MI	Last Name
Individual	RICHARD			FAULK
Insurer Type		Street Address of Practice
Licensed		2601 EAST OAKLAND PARK BLVD., STE. 600
City		State	Zip Code	County
FT. LAUDERDALE		FL	33306	Broward
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSC00-5080110		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0071987				80249

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			F	*NR
City			State	Zip Code

Location where injury occured		Other location where injury occured
Other Location
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury

Date of Occurrence		Date Reported to Insurer
4/22/2002		7/8/2003

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Depression
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
The patient alleged that she developed lithium toxicity from the insured's prescription of the drug.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
NA
Principal Injury Giving Rise To The Claim
Alleged Lithium Toxicity
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Legal Information

Date of Suit	Circuit Court Case Number
	*NR
County Suit Filed in	Date of Final Disposition
*NR	9/16/2003
Other Defendants Involved in this Claim

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?

Yes

Indemnity Paid by Insurer on behalf of Insured

$1,400

Loss Adjust Expense Paid to Defense Counsel

$3,370

All Other Loss Adjustment Expense Paid

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

Updates

No updates found.