M200218990

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	ROHRER			HEATHER
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

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
6/1/1997		1/31/2000

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Failure to protect minor from abuse by 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 of third party.
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Legal Information

Date of Suit	Circuit Court Case Number
7/5/2000	0004535
County Suit Filed in	Date of Final Disposition
Hillsborough	9/17/2001
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

$5,000

Loss Adjust Expense Paid to Defense Counsel

$2,026

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

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

Updates

No updates found.