M200533933

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 - 0490		(260) 486 - 0808(260) 486 - 0808	karina.dobberstein@ge.com

Insured Information

Type	First Name		MI	Last Name
Individual	ELIAS		E	DABUL
Insurer Type		Street Address of Practice
Licensed		140 SW 84TH AVE STE C
City		State	Zip Code	County
PLANTATION		FL	33324-2736	Broward
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
690468		$250,000		$750,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME49778		Internal Medicine - No Surgery		unkn1

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	Broward
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
7/16/2003		10/20/2003

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
BIPOLAR DISORDER
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
MEDICAL CARE AND TREATMENT
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
IMPROPER TREATMENT
Principal Injury Giving Rise To The Claim
PAIN AND SUFFERING
Severity Of Injury
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed.

Legal Information

Date of Suit	Circuit Court Case Number
	*NR
County Suit Filed in	Date of Final Disposition
*NR	11/17/2004
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
Settled by parties
Court Decision	Other
No Court Proceedings.
Arbitration
Claim not subject to Arbitration.
Date of Payment
11/17/2004

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

$833

All Other Loss Adjustment Expense Paid

$13

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.