Department File Number : | M201990564 |
Claim Number : | 105-18-0393 |
Date Submitted : | 11/11/2019 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
FAIR AMERICAN INSURANCE AND REINSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
13-3333610 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Jean | C | Bates | ||
Street Address | |||||
1401 Wilson Blvd. Suite 700 | |||||
City | State | Zip | |||
Arlington | VA | 22209 | |||
Phone | Ext | Fax | E-Mail Address | ||
(703) 907 - 3828 | (703) 276 - 9419 | Bates@prms.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Thomas | Wikstrom | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 6817 Southpoint Pkwy., Ste. 2503 | ||||
City | State | Zip Code | County | ||
Jacksonville | FL | 32216 | Duval | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
IN-FCO05-033317036 | $1,000,000 | $3,000,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME52161 | Psychiatry - All Other |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
F | Duval | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Patient's Home | |||||
Name of Institution | Code | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Date of Occurrence | Date Reported to Insurer | ||||
5/29/2019 | 6/24/2019 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Major depression | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Outpatient psychiatrist | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
*NR | |||||
Principal Injury Giving Rise To The Claim | |||||
Plaintiff alleges overprescription by Dr. Wikstrom resulted in patient's suicide attempt. | |||||
Severity Of Injury | |||||
Temporary: Major - Burns, surgical material left, drug side effect, brain damage. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
*NR | |||||
County Suit Filed in | Date of Final Disposition | ||||
*NR | 11/11/2019 | ||||
Other Defendants Involved in this Claim | |||||
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 | |||||
9/19/2019 |
Financial Information | |||||||||||||||||||||
Was there a settlement Resulting in payment to the Plaintiff? | Yes | ||||||||||||||||||||
Indemnity Paid by Insurer on behalf of Insured | $120,000 | ||||||||||||||||||||
Loss Adjust Expense Paid to Defense Counsel | $0 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
None |
Updates | |
No updates found. |
Does Dr. THOMAS WIKSTROM, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. THOMAS WIKSTROM, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).