Department File Number :

M200218987

Claim Number :

99M17118

Date Submitted :

2/1/2002

 

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

SHARON

 

LOCH

Street Address

195 Lake Louise Marie Road

City

State

Zip

Rock Hill

NY

12775

Phone

Ext

Fax

E-Mail Address

(914) 796 - 2300

5474

(914) 796 - 1801

 

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

HEATHER

 

ROHRER

Insurer Type

Street Address of Practice

Licensed

12012 BOYETTE ROAD

City

State

Zip Code

County

RIVERVIEW

FL

33569

Hillsborough

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

WM7002036

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME0063465

Physciatry - Including Child

80249

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

Other Outpatient Facility

 

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

6/1/1996

6/24/1999

 

Diagnostic Information

 

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

Failure to protect minor from abuse of third party.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Failure to protect minor from abuse by third party

Diagnostic Code :

300.4

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

failure to protect minor from abuse by third party

Principal Injury Giving Rise To The Claim

failure to protect minor from abuse by third party

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

6/4/1999

994685

County Suit Filed in

Date of Final Disposition

Hillsborough

8/16/2001

Other Defendants Involved in this Claim

TAMPA BAY ACADEMY

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

Within 90 days of 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

$15,000

Loss Adjust Expense Paid to Defense Counsel

$31,774

All Other Loss Adjustment Expense Paid

$599

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

Insured has consulted with claims personnel, medical experts and legal counsel regarding this matter.

 

Updates

 

No updates found.