The following information shall be reported on a closed claim survey form: Name of insurer; Name of insurer group; Claim file identification (ID); Name of person completing the form; Telephone number, including area code, of person completing the form; Date form completed; Date of injury; Date injury reported to insurer; Date claim closed; Whether the claim was previously reported; Age of injured person at time of injury; Gender of injured person at time of injury; Type of injury, such as wrongful death, permanent disability, or other bodily injury; Description of injury; Name of health facility where injury occurred; Type of medical professional liability policy, such as occurrence, claims made—basic, or claims made—tail; Type of patient, such as inpatient, emergency room outpatient, or other outpatient; Physician Insurance Services Office Incorporated (ISO) classification or equivalent classification; Type of health care provider, such as physician-no surgery, surgeon, psychiatrist and related specialties, nurse, nurse midwife, optometrist, pharmacist, chiropractor, podiatrist, psychologist, dentist, hospital, other health care facility, or nurse anesthetist; Physician and surgeon classification, including name of specialty; Health care provider name; Health care provider license number; Policy limits for each claim or medical incident; Policy limits for annual aggregate; If known, the facility, office, or county where the injury occurred; Whether the claim is a zero payment claim file; Full name and location of the court where the suit was filed and the case was tried; Case or docket number; Whether settlement was reached or award was made at one of the following stages: Arbitration; Mediation before suit was filed; After suit was filed, but before trial; During trial, but before court verdict; Court verdict; After verdict; or After appeal was filed; If settlement was reached or award was made by court verdict, whether the result was: Directed verdict for plaintiff; Directed verdict for defendant; Judgment notwithstanding the verdict for plaintiff; Judgment notwithstanding the verdict for defendant; Judgment for plaintiff; Judgment for defendant; Judgment for plaintiff, after appeal; Judgment for defendant, after appeal; or Any other; If there was no final judgment or settlement, the date of the final disposition; If there was no final judgment or settlement, the reason for the final disposition; If case did go to trial, whether the case was tried by a jury or tried by a judge; Total amount paid to the claimant; Amount paid by the insurer; Amount paid by the insured due to retention or deductible; If known, the amount paid by an excess carrier; If known, the amount paid by the insured due to settlement or award in excess of policy limits, not including deductible or retention amounts; If known, the amount paid by the insurer due to settlement or award in excess of policy limits, not including deductible or retention amounts; If known, the amount paid by other defendants or contributors; A summary of the occurrence from which the claim or action arose; A description of the misdiagnosis or alleged misdiagnosis made, if any, of the patient's actual condition; A description of the procedure giving rise to the claim; A description of the principal injury giving rise to the claim; The amount of past medical expenses claimed by the plaintiff; The amount of future medical expenses claimed by the plaintiff; The amount of past lost wages claimed by the plaintiff; The amount of future lost wages claimed by the plaintiff; The amount of noneconomic damages claimed by the plaintiff; The amount of other damages claimed by the plaintiff; Whether a structured settlement or periodic payment was used, and if so: The amount of immediate payment; The present value of the projected total future payout, that is, the price of the annuity, if purchased; The projected total future payout; and The cost of the structure; If a neutral expert was used, the findings of a neutral expert witness regarding future medical expenses; If a neutral expert was used, the findings of a neutral expert witness regarding future loss of earning; If case was tried to verdict: The amount awarded for past medical expenses; The amount awarded for future medical expenses; The amount awarded for past lost wages; The amount awarded for future lost wages; The amount awarded for noneconomic damages; and The amount awarded for other damages; The total allocated loss adjustment expense; Of the total allocated loss adjustment expense, the amount representing fees paid to defense counsel; Of the total allocated loss adjustment expense, the amount of expenses not included in the defense counsel fees; Whether there was a claim made for extra contractual damages; The amount claimed for extra contractual damages; Whether a suit was filed or claim was made for extra contractual damages; and Where the suit for the extra contractual damages claim was filed, including: The full name of the court where the suit was filed and the case was tried; The case number or docket number; Whether the claim settled or was tried; If tried, whether the trial was before a judge or jury; The amount paid for the extra contractual damages claim; and Whether the claim was previously reported to the Commissioner.