M200221565

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	M.K.			EL-YOUSEF
Insurer Type		Street Address of Practice
Licensed		1555 S FORT HARRISON AVE
City		State	Zip Code	County
CLEARWATER		FL	33756-2004	Pinellas
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
ML0301030		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME0022323		Physciatry - Including Child		80249

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
CHARTER BEHAVIORAL HEALTH SYSTEM OF TAMPA BAY AT TAMPA		104012
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
10/20/1996		12/7/1998

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
PATIENT TREATED FOR MAJOR RECURRENT DEPRESSION
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
ALLEGED DISCONTINUANCE OF MEDICATIONS
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
*NR
Principal Injury Giving Rise To The Claim
DISCONTINUANCE OF MEDICATION LED TO GRAND MAL SEIZURE AND ADMITTANCE INTO HOSPITAL
Severity Of Injury
Emotional Only - Fright, no physical damage

Legal Information

Date of Suit	Circuit Court Case Number
5/19/1999	99-002752CI-7
County Suit Filed in	Date of Final Disposition
Pinellas	7/11/2001
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
Claim not subject to Arbitration.
Date of Payment

Financial Information

Was there a settlement Resulting in payment to the Plaintiff?

Indemnity Paid by Insurer on behalf of Insured

Loss Adjust Expense Paid to Defense Counsel

$22,914

All Other Loss Adjustment Expense Paid

$883

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 DEFENSE COUNSEL, MEDICAL EXPERTS AND CLAIMS PERSONNEL REGARDING THIS MATTER

Updates

No updates found.