Department File Number :

M19991421

Claim Number :

A96-17371-95

Date Submitted :

2/10/2000

 

Insurer Information

 

Insurer Name

Coverage Type

FIRST PROFESSIONALS INSURANCE COMPANY, INC

Primary

Insurer FEIN

Professional License Number

59-6614702

 

Insurer Contact Information

Type

Entity Name

Entity

FLORIDA PHYSICIANS INSURANCE COMPANY

Street Address

1000 Riverside Avenue

City

State

Zip

Jacksonville

FL

32204

Phone

Ext

Fax

E-Mail Address

(904) 354 - 5910

3047

(904) 358 - 6728

collins@fpic.com

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

ALEJANDRO

F

VERGARA

Insurer Type

Street Address of Practice

Licensed

10113 Whippoorwill Lane, #416

City

State

Zip Code

County

Jacksonville

FL

32256

Duval

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

8108

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

14818

Physciatry - Including Child

0000

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

 

M

*NR

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

11/1/1995

6/10/1996

 

Diagnostic Information

 

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

Depression and suicidal ideations.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

None

Diagnostic Code :

 

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

Alleged that patient's condition was more serious than diagnosed.

Principal Injury Giving Rise To The Claim

Patient committed suicide.

Severity Of Injury

Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

2/23/1998

98-00982 CA

County Suit Filed in

Date of Final Disposition

Duval

11/2/1999

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

$350,000

Loss Adjust Expense Paid to Defense Counsel

$33,063

All Other Loss Adjustment Expense Paid

$22,753

Injured Person's Total Non-Economic Loss

$350,000

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

None

 

Updates

 

No updates found.