(a)1. The name, address, and class or line of coverage of the insured.
2. The insured’s policy number.
3. The date of the occurrence which created the claim.
4. The date the claim was reported to the insurer or self-insurer.
5. The date of suit, if filed.
6. The claimant’s name, age, and sex; however, the name of the claimant is confidential and exempt from the provisions of s. 119.07(1). 7. The total number and names of all defendants involved in the claim.
8. Claims settled after a suit was filed.
9. Claims paid based on a judgment.
10. Judgments appealed by the insurer, together with the total results of such appeals.
11. The date and amount of final judgment or settlement, if any, including the itemization of the verdict, together with a copy of the settlement or final judgment.
12. In the case of a settlement, such information as the office may require with regard to the injured person’s incurred and anticipated medical expense, wage loss, and other expenses.
13. The loss adjustment expense paid to defense counsel and other allocated loss adjustment expense paid.
14. The date and reason for final disposition, if no judgment or settlement.
(b) A summary of the occurrence which created the claim, which shall include:1. The name of the facility, business, or institution, if any, and the location within the facility, business, or institution at which the injury occurred.
2. A description of the principal injury giving rise to the claim.
3. The safety management steps that have been taken by the insured to make similar occurrences or injuries less likely in the future.
