Department File Number :

M200428696

Claim Number :

00-0007

Date Submitted :

1/23/2004

 

Insurer Information

 

Insurer Name

Coverage Type

CLARENDON NATIONAL INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

52-0266645

 

Insurer Contact Information

Type

Entity Name

Entity

WESTERN LITIGATION SPECIALISTS

Street Address

2000 W. Sam Houston Parkway South, 19th Floor

City

State

Zip

Houston

TX

77042

Phone

Ext

Fax

E-Mail Address

(713) 935 - 8868

 

(713) 461 - 8130

cynthia_roussell@ajg.com

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

JOHN

A

ORTOLANI

Insurer Type

Street Address of Practice

Licensed

1430 MASON AVENUE

City

State

Zip Code

County

DAYTONA BEACH

FL

32117-4551

Volusia

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

CMP0005262

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME34710

 

000000

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

N/A

000000

Location of Institutional Injury

Other Location of Institutional Injury

Patients' Room

 

Date of Occurrence

Date Reported to Insurer

12/14/2000

9/30/2002

 

Diagnostic Information

 

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

Headache and vision problems.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

None

Diagnostic Code :

0000000

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

Alleged failure to perform CBC with sed rate and failure to follow up resulting in progression into blindness.

Principal Injury Giving Rise To The Claim

Blindness.

Severity Of Injury

Permanent: Major - Paraplegia, blindness, loss of two limbs, brain damage.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

4/28/2003

200330308CICI

County Suit Filed in

Date of Final Disposition

Volusia

11/25/2003

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

$700,000

Loss Adjust Expense Paid to Defense Counsel

$29,226

All Other Loss Adjustment Expense Paid

$14,027

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

Unknown

 

Updates

 

No updates found.