M200429028

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	ALBERT		A	ALBATROSOV
Insurer Type		Street Address of Practice
Licensed		542 N. RIDGEWOOD AVENUE
City		State	Zip Code	County
DAYTONA BEACH		FL	32114	Volusia
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
4700000002-021		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME41127				000000

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
Prison		Orange County Jail
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury

Date of Occurrence		Date Reported to Insurer
6/1/2001		7/15/2003

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Alleged failure to treat methadone withdrawal symptoms.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Alleged failure to properly assess treatment regimen for psychiatric stabilization resulting in death of patient.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
None.
Principal Injury Giving Rise To The Claim
Death
Severity Of Injury
Permanent: Death.

Legal Information

Date of Suit	Circuit Court Case Number
5/21/2003	603CV655ORL18KRS
County Suit Filed in	Date of Final Disposition
Orange	12/2/2003
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

$85,000

Loss Adjust Expense Paid to Defense Counsel

$8,046

All Other Loss Adjustment Expense Paid

$5,309

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.