| 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) | ||||||
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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).