M200428696

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

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.

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

Deductible

Injured Person's Total Economic Loss

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

Unknown

Updates

No updates found.