M200220991

Insurer Information

Insurer Name				Coverage Type
ILLINOIS NATIONAL INSURANCE COMPANY				Primary
Insurer FEIN		Professional License Number
37-0344310
Insurer Contact Information
Type		Entity Name
Entity		WESTERN LITIGATION SPECIALISTS
Street Address
820 Gessner, Suite 1000
City				State	Zip
Houston				TX	77024
Phone	Ext	Fax	E-Mail Address
(713) 935 - 8882		(713) 722 - 1660	amy_mccombs@ajg.com

Insured Information

Type	First Name		MI	Last Name
Individual	JOHN		G	MARTIN
Insurer Type		Street Address of Practice
Licensed		4456 N.W. 100 AVENUE
City		State	Zip Code	County
CORAL SPRINGS		FL	33065	Broward
Policy Number		Per Claim Policy Limits		Aggregate Policy Limits
67658		$1,000,000		$40,000,000
Profession or Business			Other Profession or Business
Medical Doctor
License Number		Specialty Code & Classification		Certification Number
ME47187		Emergency Medicine - No Major Surgery		0

Injured Person Information

First Name	MI	Last Name		Date of Birth

Street Address			Gender	County where Injury Occurred
			M	*NR
City			State	Zip Code

Location where injury occured		Other location where injury occured
Prison		CORRECTIONAL FACILITY
Name of Institution		Code

Location of Institutional Injury		Other Location of Institutional Injury

Date of Occurrence		Date Reported to Insurer
6/27/1996		1/28/1997

Diagnostic Information

Final Diagnosis For Which Treatment Was Sought Including Patient's Actual Condition
PSYCHIATRIC TREATMENT
Operation, Diagnostic, Or Treatment Procedure Rendered Causing The Injury
ATTEMPTED SUICIDE
Diagnostic Code :
Misdiagnosis Made, If Any, Of Patient's Actual Condition
N/A
Principal Injury Giving Rise To The Claim
CIVIL RIGHTS VIOLATION
Severity Of Injury
Emotional Only - Fright, no physical damage

Legal Information

Date of Suit	Circuit Court Case Number
1/3/1997	97-6031-CIV
County Suit Filed in	Date of Final Disposition
Broward	5/29/2002
Other Defendants Involved in this Claim

Stage of Legal System at which Settlement was Reached or Award Made
More than 90 days, after suit filed and prior to or during the course of mandatory settlement conference.
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?

Yes

Indemnity Paid by Insurer on behalf of Insured

$10,000

Loss Adjust Expense Paid to Defense Counsel

$36,887

All Other Loss Adjustment Expense Paid

$1,775

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

UNKNOWN

Updates

No updates found.