Department File Number :

M200221563

Claim Number :

00M18997

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

STEPHEN

J

SZABO

Insurer Type

Street Address of Practice

Licensed

16201 AVILA BLVD.

City

State

Zip Code

County

TAMPA

FL

33613

Hillsborough

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

CM0501480

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME0024588

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

 

M

*NR

City

State

Zip Code

 

 

 

Location where injury occured

Other location where injury occured

Hospital Inpatient Facility

 

Name of Institution

Code

SAINT JOSEPH'S HOSPITAL

100075

Location of Institutional Injury

Other Location of Institutional Injury

Other

PSYCHIATRIC FLOOR

Date of Occurrence

Date Reported to Insurer

8/31/1999

1/6/2000

 

Diagnostic Information

 

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

SUICIDE

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

FAILURE TO PREVENT SUICIDE

Diagnostic Code :

 

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

FAILURE TO MONITOR SUICIDAL PATIENT

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

3/19/2001

01002193

County Suit Filed in

Date of Final Disposition

Hillsborough

9/24/2001

Other Defendants Involved in this Claim

 

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

Claim or suit abandoned.

Final Method of Claim Disposition

Disposed of by Court

Court Decision

Other

Other

 

Arbitration

Claim not subject to Arbitration.

Date of Payment

 

 

Financial Information

 

Was there a settlement Resulting in payment to the Plaintiff?

No

Indemnity Paid by Insurer on behalf of Insured

$0

Loss Adjust Expense Paid to Defense Counsel

$7,429

All Other Loss Adjustment Expense Paid

$436

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.