Department File Number : | M201885089 |
Claim Number : | 1043499-01 |
Date Submitted : | 9/27/2018 |
Insurer Information | |||||
Insurer Name | Coverage Type | ||||
NATIONAL FIRE & MARINE INSURANCE COMPANY | Primary | ||||
Insurer FEIN | Professional License Number | ||||
47-6021331 | |||||
Insurer Contact Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Taffie | Hosler | |||
Street Address | |||||
5814 Reed Rd | |||||
City | State | Zip | |||
Fort Wayne | IN | 46835 | |||
Phone | Ext | Fax | E-Mail Address | ||
(260) 492 - 4061 | taffie.hosler@medpro.com |
Insured Information | |||||
Type | First Name | MI | Last Name | ||
Individual | Ghulam | Mohammed | |||
Insurer Type | Street Address of Practice | ||||
Licensed | 333 N Byron Butler Pkwy | ||||
City | State | Zip Code | County | ||
Perry | FL | 32347 | Taylor | ||
Policy Number | Per Claim Policy Limits | Aggregate Policy Limits | |||
HN004730 | $250,000 | $750,000 | |||
Profession or Business | Other Profession or Business | ||||
Medical Doctor | |||||
License Number | Specialty Code & Classification | Certification Number | |||
ME63587 | Hospitalists |
Injured Person Information | |||||
First Name | MI | Last Name | Date of Birth | ||
Street Address | Gender | County where Injury Occurred | |||
M | Taylor | ||||
City | State | Zip Code | |||
Location where injury occured | Other location where injury occured | ||||
Other Location | Taylor County Jail | ||||
Name of Institution | Code | ||||
DOCTORS' MEMORIAL HOSPITAL (PERRY) | 100106 | ||||
Location of Institutional Injury | Other Location of Institutional Injury | ||||
Other | Taylor County Jail | ||||
Date of Occurrence | Date Reported to Insurer | ||||
7/27/2013 | 5/10/2017 |
Diagnostic Information | |||||
Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition | |||||
Patient taken to county jail after arrest | |||||
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury | |||||
Examined, patient not to need treatment | |||||
Diagnostic Code : | |||||
Misdiagnosis Made, If Any, Of Patient's Actual Condition | |||||
42 USC 1983 Civil Right violation, deliberate indifference to medical needs. | |||||
Principal Injury Giving Rise To The Claim | |||||
Broken rib, bleeding, abrasion, pain | |||||
Severity Of Injury | |||||
Temporary: Minor - Infections, misset fracture, fall in hospital. Recovery delayed. |
Legal Information | |||||
Date of Suit | Circuit Court Case Number | ||||
4/10/2017 | 4:17-cv-001210RH-CAS | ||||
County Suit Filed in | Date of Final Disposition | ||||
Taylor | 3/26/2018 | ||||
Other Defendants Involved in this Claim | |||||
Stage of Legal System at which Settlement was Reached or Award Made | |||||
During appeal. | |||||
Final Method of Claim Disposition | |||||
No Payment Made | |||||
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 | $21,544 | ||||||||||||||||||||
All Other Loss Adjustment Expense Paid | $0 | ||||||||||||||||||||
Injured Person's Total Non-Economic Loss | $0 | ||||||||||||||||||||
Deductible | $0 | ||||||||||||||||||||
Injured Person's Total Economic Loss | |||||||||||||||||||||
| |||||||||||||||||||||
Safety Management Steps Taken by Insured to Make Similar Occurrence Less Likely | |||||||||||||||||||||
n/a |
Updates | |||||||
Date of Change: | 9/27/2018 2:55:16 PM | ||||||
Reason for Change: | ALE update (loss adjusted/counsel) | ||||||
|
This page is not displaying certain sensitive information.
Does Dr. GHULAM MOHAMMED, MD have any medical malpractice cases, lawsuits, or complaints?
Dr. GHULAM MOHAMMED, MD has at least 1 medical malpractice case(s), lawsuit(s), or complaint(s).