Department File Number :

M200221526

Claim Number :

00M19633

Date Submitted :

9/9/2002

 

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 Rd

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

THOMAS

E

UTTLEY

Insurer Type

Street Address of Practice

Licensed

43 BARKLEY CIR

City

State

Zip Code

County

FORT MYERS

FL

33907-4510

Lee

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

WM0090021

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME0051128

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

Prison

deliberately stepped in front of truck

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

 

 

Date of Occurrence

Date Reported to Insurer

12/23/1998

3/17/2000

 

Diagnostic Information

 

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

SUICIDAL TENDENCIES

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

FAILURE TO TREAT APPROPRIATELY, PREMATURELY DISCHARGED PATIENT

Diagnostic Code :

 

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

*NR

Principal Injury Giving Rise To The Claim

SUICIDE

Severity Of Injury

Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

 

Legal Information

 

Date of Suit

Circuit Court Case Number

1/30/2001

0010617CA

County Suit Filed in

Date of Final Disposition

Lee

3/28/2002

Other Defendants Involved in this Claim

 

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

Award for plaintiff.

Date of Payment

 

 

Financial Information

 

Was there a settlement Resulting in payment to the Plaintiff?

Yes

Indemnity Paid by Insurer on behalf of Insured

$250,000

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

THE INSURED HAS CONSULTED WITH DEFENSE COUNSEL, MEDICAL EXPERTS AND CLAIMS PERSONNEL REGARDING THIS MATTER.

 

Updates

 

No updates found.