Department File Number :

M200432809

Claim Number :

98434

Date Submitted :

9/14/2004

 

Insurer Information

 

Insurer Name

Coverage Type

MEDICAL PROTECTIVE COMPANY (THE)

Primary

Insurer FEIN

Professional License Number

35-0506406

 

Insurer Contact Information

Type

First Name

MI

Last Name

Individual

Karina

L

Dobberstein

Street Address

5814 Reed Rd

City

State

Zip

Fort Wayne

IN

46835

Phone

Ext

Fax

E-Mail Address

(260) 486 - 0490

 

(260) 486 - 0808

karina.dobberstein@ge.com

 

Insured Information

 

Type

First Name

MI

Last Name

Individual

NABIL

A

DAJANI

Insurer Type

Street Address of Practice

Licensed

12775 SEMINOLE BLVD

City

State

Zip Code

County

LARGO

FL

33778

Pinellas

Policy Number

Per Claim Policy Limits

Aggregate Policy Limits

607062

$1,000,000

$3,000,000

Profession or Business

Other Profession or Business

Medical Doctor

 

License Number

Specialty Code & Classification

Certification Number

ME62953

Psychiatry - All Other

 

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

Pinellas

City

State

Zip Code

 

 

 

Location where injury occured

Other location where injury occured

Physician's Office

 

Name of Institution

Code

 

 

Location of Institutional Injury

Other Location of Institutional Injury

Special Procedure Room

 

Date of Occurrence

Date Reported to Insurer

5/26/1999

8/2/2001

 

Diagnostic Information

 

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

BIPOLAR DISORDER, PARANOIA, DEPRESSION

Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury

ADMIT TO MENTAL HEALTH FACILITY

Diagnostic Code :

 

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

IMPROPER TREATMENT

Principal Injury Giving Rise To The Claim

BRAIN DAMAGE

Severity Of Injury

Permanent: Grave - Quadraplegia, severe brain damage, lifelong care or fatal prognosis.

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

7/30/2004

Other Defendants Involved in this Claim

 

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

Within the pre-suit period as set forth in 766.106 (more than 90 days before suit is filed).

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?

No

Indemnity Paid by Insurer on behalf of Insured

$0

Loss Adjust Expense Paid to Defense Counsel

$2,055

All Other Loss Adjustment Expense Paid

$4

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

N/A

 

Updates

 

No updates found.