Department File Number :

M200430436

Claim Number :

DM06627853-09T001

Date Submitted :

4/21/2004

 

Insurer Information

 

Insurer Name

Coverage Type

ST. PAUL FIRE & MARINE INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

41-0406690

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

PAT

 

KANE

Street Address

3230 W. Commercial Blvd., Suite 390

City

State

Zip

Ft. Lauderdale

FL

33309

Phone

Ext

Fax

E-Mail Address

(954) 677 - 3324

 

(954) 735 - 9028

 

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

WILLIAM

C

WILSON, DO

Insurer Type

Street Address of Practice

Licensed

908 GARDEN GATE CIRCLE

City

State

Zip Code

County

PENSACOLA

FL

32504

Escambia

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

DM06627853

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

OS5519

Family Physicians or General Practitioners - Minor Surgery

01

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

Prison

Physician's Office

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

5/29/2000

1/18/2002

 

Diagnostic Information

 

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

Patient was being seen for situation depression

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

No procedure caused the injury in this claim; plaintiff alleging abandonment even though Dr. Wilson did not have privileges at Lakeview Center where plaintiff was Baker Acted after overdosing on drugs

Diagnostic Code :

 

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

None

Principal Injury Giving Rise To The Claim

Fractured jaw-happened after being Baker Acted to Lakeview Center, co-defendant in this matter.

Severity Of Injury

Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

1/6/2003

2002 CA 002481

County Suit Filed in

Date of Final Disposition

Escambia

3/31/2004

Other Defendants Involved in this Claim

LAKEVIEW CENTER

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

$62,500

Loss Adjust Expense Paid to Defense Counsel

$15,500

All Other Loss Adjustment Expense Paid

$0

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

None

 

Updates

 

No updates found.