Department File Number :	M200327389
Claim Number :	0572MA2037-09J014
Date Submitted :	11/21/2003

Insurer Information
Insurer Name				Coverage Type
ST. PAUL FIRE & MARINE INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
41-0406690
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	PAT			KANE
Street Address
3230 W. Commercial Blvd., Suite 390
City				State	Zip
Ft. Lauderdale				FL	33309
Phone	Ext	Fax	E-Mail Address
(954) 677 - 3324		(954) 735 - 9028

Insured Information
Type	First Name		MI	Last Name
Individual	EULOGIA			VIZCARRA, MD
Insurer Type		Street Address of Practice
Licensed		721 S. JEFFERSON STREET
City		State	Zip Code	County
PERRY		FL	32347	Taylor
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
0572MA2037		$1,000,000		$3,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME30012		Internal Medicine - Minor Surgery		01

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
Prison		Infirmary-Calhoun Correctional
Name of Institution		Code
Location of Institutional Injury		Other Location of Institutional Injury
Date of Occurrence		Date Reported to Insurer
10/19/1998		5/25/2000

Diagnostic Information

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

Injured hernia

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Plaintiff alleged he re-injured his hernia because he was not assigned to lighter duty

Diagnostic Code :

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

None

Principal Injury Giving Rise To The Claim

Hernia

Severity Of Injury

Temporary: Slight - Lacerations, contusions, minor scars, rash. No delay.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information
Date of Suit	Circuit Court Case Number
5/24/2000	4-00 CV98 WS
County Suit Filed in	Date of Final Disposition
Leon	7/14/2003
Other Defendants Involved in this Claim
Stage of Legal System at which Settlement was Reached or Award Made
After appeal.
Final Method of Claim Disposition
Disposed of by Court
Court Decision	Other
Directed verdict for defendant.
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

$16,450

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

None

Updates

No updates found.