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

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