M200432809

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

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.

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?

Indemnity Paid by Insurer on behalf of Insured

Loss Adjust Expense Paid to Defense Counsel

$2,055

All Other Loss Adjustment Expense Paid

Injured Person's Total Non-Economic Loss

Deductible

Injured Person's Total Economic Loss

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

N/A

Updates

No updates found.