Department File Number :

Insurer Information

Insurer Name				Coverage Type
FIRST PROFESSIONALS INSURANCE COMPANY, INC				Primary
Insurer FEIN		Professional License Number
59-6614702
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	CHERI		M	MONTAGUE
Street Address
1000 Riverside Ave., Suite 800
City				State	Zip
Jacksonville				FL	32204
Phone	Ext	Fax	E-Mail Address
(904) 354 - 5910	3043	(904) 358 - 6728	montague@FPIC.com

Insured Information

Type	First Name		MI	Last Name
Individual	VELUKUTTY			BALAKRISHNAN, M.D.
Insurer Type		Street Address of Practice
Licensed		105 N. OSCEOLA AVENUE
City		State	Zip Code	County
INVERNESS		FL	34450	Citrus
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
23143		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
43309		Internal Medicine - No Surgery		80257

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
Hospital Inpatient Facility
Name of Institution		Code
CITRUS MEMORIAL HOSPITAL		100023
Location of Institutional Injury		Other Location of Institutional Injury
Patients' Room
Date of Occurrence		Date Reported to Insurer
4/8/1999		1/30/2001

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
KIDNEY TUMOR.
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
KIDNEY EMBOLIZATION.
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
ALLEGED UNDIAGNOSED FLUID IMBALANCE.
Principal Injury Giving Rise To The Claim
DEATH.
Severity Of Injury
Permanent: Death.

Legal Information

Date of Suit	Circuit Court Case Number
6/12/2001	2001 CA 1726
County Suit Filed in	Date of Final Disposition
Citrus	3/18/2003
Other Defendants Involved in this Claim
CITRUS MEMORIAL HOSPITAL
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?

Yes

Indemnity Paid by Insurer on behalf of Insured

$150,000

Loss Adjust Expense Paid to Defense Counsel

$32,472

All Other Loss Adjustment Expense Paid

$22,572

Injured Person's Total Non-Economic Loss

$130,000

Deductible

Injured Person's Total Economic Loss

Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely

NONE KNOWN.

Updates

No updates found.