Department File Number :

M200218703

Claim Number :

00-0457

Date Submitted :

1/7/2002

 

Insurer Information

 

Insurer Name

Coverage Type

LEGION INSURANCE COMPANY

Primary

Insurer FEIN

Professional License Number

23-1892289

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

DAVID

M

EAKIN

Street Address

1515 Wilson Blvd. , Suite 800

City

State

Zip

Arlington

VA

22209

Phone

Ext

Fax

E-Mail Address

(703) 907 - 3800

339

(703) 276 - 9419

David M. Eakin

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

DHVANIT

 

VIJAPURA

Insurer Type

Street Address of Practice

Licensed

221 E. 23RD STREET, #F

City

State

Zip Code

County

PANAMA CITY

FL

32405

Bay

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

PL4-262533

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME059359

Physciatry - Including Child

-

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

Nursing Home

 

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

3/7/2001

7/24/2001

 

Diagnostic Information

 

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

Abnormal Heartbeat

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Evaluation

Diagnostic Code :

 

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

N/A

Principal Injury Giving Rise To The Claim

Emotional

Severity Of Injury

Emotional Only - Fright, no physical damage

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

 

*NR

County Suit Filed in

Date of Final Disposition

*NR

11/13/2001

Other Defendants Involved in this Claim

 

Stage of Legal System at which Settlement was Reached or Award Made

After arbitration is initiated or prior to suit being filed.

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

$25,000

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

 

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

N/A

 

Updates

 

No updates found.