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Claim Number :
Department File Number :
Licensed Insurer Name :
Licensed Insurer FEIN :
Licensed Insurer NAIC Company Code :
Self Insurer First Name :
Self Insurer Last Name :
Self Insurer Entity Name :
Self Insurer Prof. License Number :
Insured Policy Number :
Insured First Name :
Insured Last Name :
Insured Entity Name :
Insured License Number :
Date Injury Occurred :
To
Date Injury Reported :
To
Court Case Number :
Final Disposition :
Settled by parties
Disposed of by Court
Disposed of by Arbitration
Dropped before Action Filed
No Payment Made
Date of Final Disposition :
To
Court Decision :
No Court Proceedings.
Directed verdict for plaintiff.
Directed verdict for defendant.
Judgment notwithstanding the verdict for plaintiff.
Judgment notwithstanding the verdict for defendant.
Judgment for the plaintiff.
Judgment for the defendant.
Judgment for the plaintiff after appeal ...
Judgment for the defendant after the appeal ...
Summary judgment for the plaintiff.
Summary judgment for the defendant.
Other
County Suit Filed In :
Alachua
Baker
Bay
Bradford
Brevard
Broward
Calhoun
Charlotte
Citrus
Clay
Collier
Columbia
Dade
Desoto
Dixie
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Martin
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Pinellas
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Putnam
Santa Rosa
Sarasota
Seminole
St. Johns
St. Lucie
Sumter
Suwannee
Taylor
Union
Volusia
Wakulla
Walton
Washington
Out of state
Arbitration :
Claim not subject to Arbitration.
Claim subject to arbitration, but settlement reached in lieu of award.
Award for plaintiff.
Award for defendant.
Date Suit Filed :
To
Stage Settlement Reached :
Claim Dropped or Dismissed
As a Result of Arbitration
Suit Filed but Settlement Reached Before Trial
During Trial, but Before Court Verdict
Court Verdict
Settlement Reached After Verdict
Settlement was Reached After Appeal was Filed
No Response
Settlement Reached Prior to Pre-Suit Period
Indemnity Paid :
Range ($):
Deductible Paid by Defendant :
Range ($):
Date Submitted :
To
Date Updated :
To