Department File Number :

M200221796

Claim Number :

202605

Date Submitted :

9/25/2002

 

Insurer Information

 

Insurer Name

Coverage Type

DOCTORS' COMPANY, AN INTERINSURANCE EXCHANGE (THE)

Primary

Insurer FEIN

Professional License Number

95-3014772

 

Insurer Contact Information

Type

Entity Name

Entity

THE DOCTORS COMPANY

Street Address

13450 W. Sunrise Boulevard, Suite 160

City

State

Zip

Sunrise

FL

33323

Phone

Ext

Fax

E-Mail Address

(954) 858 - 0213

 

(954) 838 - 7480

ahinkson@thedoctors.com

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

ASHIT

 

VIJAPURA

Insurer Type

Street Address of Practice

Licensed

1601 W REYNOLDS ST STE 102

City

State

Zip Code

County

PLANT CITY

FL

33563-4708

Hillsborough

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

15298

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME0050556

Physciatry - Including Child

0000000000

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

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

8/27/1996

3/18/1999

 

Diagnostic Information

 

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

Chronic paranoid schizophrenia.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Failure to monitor.

Diagnostic Code :

710

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

None.

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

4/19/1999

97-5630 F

County Suit Filed in

Date of Final Disposition

Hillsborough

7/31/2002

Other Defendants Involved in this Claim

 

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

After court verdict and prior to filing of notice of appeal.

Final Method of Claim Disposition

Disposed of by Court

Court Decision

Other

Judgment for the plaintiff.

 

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

$120,000

Loss Adjust Expense Paid to Defense Counsel

$61,610

All Other Loss Adjustment Expense Paid

$38,700

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

Unknown.

 

Updates

 

No updates found.