Department File Number :	M200011214
Claim Number :	97M09487
Date Submitted :	5/15/2000

Insurer Information
Insurer Name				Coverage Type
FRONTIER INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
13-2559805
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	CAROL			LOBACZ
Street Address
6360 NW 5TH WAY, SUITE 303
City				State	Zip
FT. LAUDERDALE				FL	33309
Phone	Ext	Fax	E-Mail Address
(954) 491 - 6078	111	(954) 491 - 6610

Insured Information
Type	First Name		MI	Last Name
Individual	GUILLERMO			MARCOVICI, MD
Insurer Type		Street Address of Practice
Licensed		1111 12 ST # 204
City		State	Zip Code	County
KEY WEST		FL	33040	Monroe
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
RML0301441-5100		$500,000		$1,500,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0037469		Physciatry - Including Child		NA

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
Prison		MONROE COUNTY JAIL
Name of Institution		Code
Location of Institutional Injury		Other Location of Institutional Injury
Date of Occurrence		Date Reported to Insurer
9/12/1995		8/19/1997

Diagnostic Information

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

DEPRESSION

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

FAILURE TO FOLLOW INSTITUTIONAL POLICIES OR PROCEDURES RESULTING IN SUICIDE ATTEMPTS RESULTING IN EMOTIONAL DISTRESS

Diagnostic Code :

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

NA

Principal Injury Giving Rise To The Claim

EMOTIONAL DISTRESS

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
5/15/1997	96-10129 CIUPAINE
County Suit Filed in	Date of Final Disposition
Monroe	3/23/2000
Other Defendants Involved in this Claim
MCCRAY, PSY, MARVIN REMLEY, LT. RICHARD MUMFORD, CHEIF MEDI, MR WHALEN WARDON, PATRICK COLLINS, CHEIF MEDI, TERRY DEJESUS, PSY, SELMA
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

$2,000

Loss Adjust Expense Paid to Defense Counsel

$51,408

All Other Loss Adjustment Expense Paid

$3,040

Injured Person's Total Non-Economic Loss

$2,000

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

THE INSURED HAS CONSULTED WITH DEFENSE COUNSEL AND CLAIMS PERSONEL REGARDING THIS MATTER

Updates

No updates found.