M200219432

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 EAST 23RD STREET, SUITE 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
ME0059359		Physciatry - Including Child		-

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
11/1/2000		7/23/2001

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
Chemical Dependency Disorder
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
Physical examination
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
Emotional injury claimed
Severity Of Injury
Emotional Only - Fright, no physical damage

Legal Information

Date of Suit	Circuit Court Case Number
	*NR
County Suit Filed in	Date of Final Disposition
*NR	2/12/2002
Other Defendants Involved in this Claim

Stage of Legal System at which Settlement was Reached or Award Made
Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is 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

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

N/A

Updates

No updates found.