Department File Number :	M200432085
Claim Number :	19506-01
Date Submitted :	7/21/2004

Insurer Information
Insurer Name				Coverage Type
AMERICAN PHYSICIANS ASSURANCE CORPORATION				Primary
Insurer FEIN		Professional License Number
38-2102867
Insurer Contact Information
Type	First Name		MI	Last Name
Individual	Nancy			Kirsch
Street Address
327 Plaza Real, Suite 319
City				State	Zip
Boca Raton				FL	33432
Phone	Ext	Fax	E-Mail Address
(561) 362 - 3332		(561) 417 - 6125	nkirsch@acaponline.com

Insured Information
Type	First Name		MI	Last Name
Individual	Antonio			Perez-Noy
Insurer Type		Street Address of Practice
Licensed		1534 Palancia Ave
City		State	Zip Code	County
Coral Gables		FL	33146	Dade
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
127200		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME 0053247		Physcoanalysis

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	Dade
City			State	Zip Code
Location where injury occured		Other location where injury occured
Other Hospital/Institution		Assisted Living Facility
Name of Institution		Code
Location of Institutional Injury		Other Location of Institutional Injury
Other		Las Flores Home
Date of Occurrence		Date Reported to Insurer
1/1/1999		1/9/2003

Diagnostic Information

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

Psychiatric disorder.

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

Death by suicide.

Diagnostic Code :

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

*NR

Principal Injury Giving Rise To The Claim

Patient was placed in ALF and had been living there for approx. two years. Patient committed suicide on 8/26/2000. Insured was never formally put on notice but reported the death to comply with incident reporting policy of the carrier.

Severity Of Injury

Permanent: Death.

Florida Office of Insurance Regulation
Medical Malpractice Closed Claims Report

Legal Information
Date of Suit	Circuit Court Case Number
	*NR
County Suit Filed in	Date of Final Disposition
*NR	4/7/2004
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
Dropped before Action Filed
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?

No

Indemnity Paid by Insurer on behalf of Insured

$0

Loss Adjust Expense Paid to Defense Counsel

$0

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

Insured consutled with Claims Personnel regarding the matter. Insured was never formally named in any claim. No payment was made on behalf of the insured.

Updates

No updates found.