M200328013

Insurer Information

Insurer Name				Coverage Type
LEXINGTON INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
25-1149494
Insurer Contact Information
Type		Entity Name
Entity		PROFESSIONAL RISK MANAGEMENT SERVICES, INC.
Street Address
1515 Wilson Boulevard, Suite 800
City				State	Zip
Arlington				VA	22209
Phone	Ext	Fax	E-Mail Address
(703) 907 - 3800	352	(703) 276 - 9419	torrans@prms.com

Insured Information

Type	First Name		MI	Last Name
Individual	CHARLES		J	DACK
Insurer Type		Street Address of Practice
Licensed		1952 EAST EDGEWOOD DRIVE, SUITE M3
City		State	Zip Code	County
LAKELAND		FL	33803	Polk
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PSC00-0629490		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0036598		Physciatry - Including Child		N/A

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
Patient's Home
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury

Date of Occurrence		Date Reported to Insurer
3/13/2002		10/10/2002

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Major depression, chronic pain.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged that Dr. Dack negiligently treated patient Tuxbury with inappropriate dosages of Elavil and MS-Contin.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
Death of Patient Tuxbury.
Severity Of Injury
Permanent: Death.

Legal Information

Date of Suit	Circuit Court Case Number
1/17/2003	53-2003CA0001240000
County Suit Filed in	Date of Final Disposition
Polk	10/27/2003
Other Defendants Involved in this Claim
AHMED, SYED W MID-FLORIDA INTERNAL MEDICINE ASSOCIATES PA
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

$125,000

Loss Adjust Expense Paid to Defense Counsel

$24,626

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

$125,000

Deductible

Injured Person's Total Economic Loss

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

N/A

Updates

No updates found.