Department File Number :	M200325037
Claim Number :	E29017-03
Date Submitted :	6/10/2003

Insurer Information
Insurer Name				Coverage Type
PRONATIONAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
38-2317569
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	ANTHONY			DAPORE
Street Address
13919 Carrollwood Village Run, Suite A
City				State	Zip
Tampa				FL	33624
Phone	Ext	Fax	E-Mail Address
(813) 969 - 2010		(813) 969 - 2120	ADapore@proassurance.com

Insured Information
Type	First Name		MI	Last Name
Individual	SAMPATHKUMAR			SHANMUGHAM
Insurer Type		Street Address of Practice
Licensed		1403 MEDICAL PLAZA DRIVE, SUITE 204
City		State	Zip Code	County
SANFORD		FL	32771	Seminole
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
PNFL-1006754-00		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0050877		Neurology - Including Child - No Surgery		00000

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
			F	*NR
City			State	Zip Code
Location where injury occured		Other location where injury occured
Hospital Inpatient Facility
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
2/24/1998		3/27/2000

Diagnostic Information

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

Subdural empyema in 17 year old female.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Observtion and conservative treatment with infectious disease consult managing antibiotics, alleged delay in neurosurgery consult.

Diagnostic Code :

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

None.

Principal Injury Giving Rise To The Claim

Alleged cognitive loss in 17 year old female following craniotomy for subdural empyema.

Severity Of Injury

Permanent: Significant - Deafness, loss of limb, loss of eye, loss of one kidney or lung.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information
Date of Suit	Circuit Court Case Number
10/17/2000	00-CA-1280 09 P
County Suit Filed in	Date of Final Disposition
Seminole	5/22/2003
Other Defendants Involved in this Claim
KNAPP, M.D., MARK J PULMONARY PRACTICE ASSOC., M.D., P.A. PANJA, M.D., JAWED FLORIDA NEUROLOGY, P.A.
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

$100,000

Loss Adjust Expense Paid to Defense Counsel

$36,324

All Other Loss Adjustment Expense Paid

$68,286

Injured Person's Total Non-Economic Loss

$100,000

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

Insured has discussed case with insurance company personnel, medical experts and defense counsel.

Updates

No updates found.