M200432075

Insurer Information

Insurer Name				Coverage Type
AMERICAN PHYSICIANS ASSURANCE CORPORATION				Primary
Insurer FEIN		Professional License Number
38-2102867
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	steffanie			simon
Street Address
327 plaza real, suite 319
City				State	Zip
boca raton				FL	33432
Phone	Ext	Fax	E-Mail Address
(561) 362 - 3334		(561) 417 - 6125	ssimon@acaponline.com

Insured Information

Type	First Name		MI	Last Name
Individual	SAMPATHKUMAR			SHANMUGHAM
Insurer Type		Street Address of Practice
Licensed		1403 MEDICAL PLAZA DR., SUITE 204
City		State	Zip Code	County
SANFORD		FL	32771	Seminole
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
127014		$500,000		$1,500,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0050877		Neurology - including child - no surgery - All Other		N/A

Injured Person Information

First Name	MI	Last Name		Date of Birth

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

Location where injury occured		Other location where injury occured
Emergency Room
Name of Institution		Code
CENTRAL FLORIDA REGIONAL HOSPITAL (SANFORD)		100161
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
2/6/2003		4/23/2003

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
RECURRENT EPISODES OF LEFT SIDED PARENTHSIS AND WEAKNESS
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
IT IS ALLEGED INSURED INAPPROPRIATELY ORDERED AND ADMINISTERED HEPARIN THERAPY WHICH CAUSED AN INTRACRANIAL BLEED AND RESULTED IN HER DEATH.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
DEATH
Severity Of Injury
Permanent: Death.

Legal Information

Date of Suit	Circuit Court Case Number
	*NR
County Suit Filed in	Date of Final Disposition
*NR	7/8/2004
Other Defendants Involved in this Claim
FLORIDA NEUROLOGY, PA
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?

Indemnity Paid by Insurer on behalf of Insured

Loss Adjust Expense Paid to Defense Counsel

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

INSURED CONSULTED WITH DEFENSE COUNSEL AND CLAIMS PERSONNEL REGARDING THIS MATTER. NO PAYMENT WAS MADE.

Updates

No updates found.