47411393-E3B2-7F55-0865EAB909BEF818.xlsx

XLSX spreadsheet 42 KB Posted

Attached to
Audio Visual System for Conference Room
Solicitation number
RFP 2026-10-09
Issued by
Franklin County, Ohio

About this file

This file is a Short Term Disability (STD) claims status detail report for the Franklin County Cooperative Health Improvement Program (Customer ID: 0157775), covering the period from January 1, 2022, through July 31, 2025. The report provides comprehensive claims data including claimant demographics, disability classifications, claim dates, benefit amounts, and claim status outcomes. The document contains records for 493 total claims processed during this period, with claim statuses categorized as Closed, Denied, Pending, Open, or Suspended. Each claim entry includes information such as claimant age, gender, accident/sickness designation, occupational/non-occupational classification, disability date, benefit start date, claim end date, base benefit amount, and cumulative gross benefit paid.

The aggregate gross benefit amount disbursed for all claims under Customer 0157775 totals $2,234,179.52 across the 493 claims processed. The claims data reflects a mixed portfolio of approved and denied claims, with benefit amounts ranging from nominal denials to significant cumulative benefits exceeding $30,000 for individual claimants. The report was generated on August 13, 2025, and documents the claims experience for what appears to be a cooperative health benefit program serving a multi-employer or governmental consortium, though the specific funding sources and premium structures are not detailed in this summary document.

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Sheet1

FRANKLIN COUNTY COOPERATIVE HEALTH IMPROVEMENT PRO
Claim Status Detail
Short Term Disability
Data as of: 07/30/2025From: 01/01/2022To: 07/31/2025
Customer: 0157775
Claim StatusGenderClaimant Age - YearsAcc/SickOcc/Non-OccDisability DateBenefit Start DateClaim End DateBase BenefitCumulative Gross Benefit
DeniedM61SN11/26/201912/10/201911/26/2019$372.00$0.00
ClosedM60SN10/5/202110/19/20212/6/2022$633.36$10,043.28
ClosedF31SN12/27/20211/10/20222/20/2022$529.68$1,801.32
DeniedF42SN12/28/20211/11/20221/6/2022$483.36$0.00
DeniedF49SN3/17/20223/31/20223/17/2022$476.16$0.00
ClosedF65SN6/22/20227/6/202211/6/2022$635.75$11,261.86
ClosedF53SN7/25/20228/8/20228/21/2022$750.24$1,500.48
ClosedM64SN7/27/20228/10/20229/3/2022$396.24$1,867.99
DeniedM31SN8/5/20228/19/20228/5/2022$571.68$0.00
ClosedF65SN8/29/20229/12/202210/31/2022$574.32$4,102.29
DeniedM66SN1/4/20231/18/20231/4/2023$678.00$0.00
ClosedM58SN3/22/20234/5/20236/14/2023$762.92$5,353.80
ClosedM39AN6/25/20237/9/20239/10/2023$840.25$6,867.04
DeniedM51SN8/15/20238/29/20238/15/2023$488.88$0.00
ClosedF30SN10/4/202310/18/202311/14/2023$609.60$267.03
ClosedF25SN10/11/202310/25/20231/1/2024$547.44$5,396.20
ClosedF48SN11/8/202311/22/20232/8/2024$684.00$7,719.43
ClosedM53SN1/3/20241/17/20243/27/2024$1,482.85$6,709.77
DeniedF67SN1/4/20241/18/20241/4/2024$531.12$0.00
ClosedM65SN12/15/202312/29/20232/11/2024$675.36$3,809.95
ClosedM71SN2/13/20242/27/20244/30/2024$752.40$6,879.08
ClosedF34SN3/15/20243/29/20244/24/2024$565.44$2,180.98
ClosedF43SN3/20/20244/3/202410/4/2024$553.44$14,331.79
ClosedF48SN3/26/20244/9/20248/13/2024$928.32$15,164.79
DeniedF59SN6/4/20246/18/20246/4/2024$725.76$0.00
ClosedF34SN5/8/20245/22/20245/27/2024$565.44$1,292.44
ClosedF26SN7/1/20247/15/20248/4/2024$646.85$1,940.55
ClosedF45SN5/23/20246/6/20246/19/2024$559.44$1,118.88
ClosedF56SN6/12/20246/26/20247/18/2024$444.00$1,458.86
DeniedF22SN11/12/202411/26/202411/12/2024$25.00$0.00
ClosedF27SN10/10/202410/24/202412/4/2024$886.80$150.00
DeniedF62SN10/18/202411/1/202410/18/2024$955.43$0.00
ClosedM43SN10/3/202410/17/202411/17/2024$636.24$2,908.53
ClosedF50SN12/16/202412/30/20246/29/2025$595.68$14,917.00
ClosedM59SN12/28/20241/11/20257/11/2025$553.20$14,383.20
ClosedF48SN2/3/20252/17/20253/30/2025$655.92$3,935.52
OpenF60SN2/3/20252/17/20258/7/2025$678.72$13,574.40
ClosedF34SN2/3/20252/17/20252/24/2025$607.12$28.57
ClosedF49SN3/28/20254/11/20257/27/2025$552.00$8,437.71
DeniedM51SN3/10/20253/24/20253/10/2025$579.12$0.00
ClosedM22SN4/9/20254/23/20255/14/2025$458.31$1,440.40
ClosedF61SN4/27/20255/11/20256/25/2025$500.64$3,289.92
PendingF67SN7/18/20258/1/20257/18/2025$698.40$0.00
ClosedF31SN5/26/20256/9/20257/6/2025$782.88$3,131.52
OpenF45SN6/25/20257/9/20258/19/2025$647.76$1,758.21
ClosedF49AN4/10/20254/24/20256/29/2025$599.28$4,933.39
PendingF55SN6/16/20256/30/20257/27/2025$692.16$0.00
ClosedF66SN12/9/202112/23/20213/6/2022$512.16$3,879.71
ClosedF60SN3/21/20224/4/20226/12/2022$481.68$3,903.44
ClosedM31SN4/21/20225/5/20228/29/2022$571.68$7,848.69
ClosedF31SN4/2/20224/16/20225/16/2022$597.84$1,053.34
ClosedF52SN5/31/20226/14/202212/12/2022$699.60$16,840.41
ClosedF39SN11/21/202212/5/20221/20/2023$1,157.09$4,733.45
ClosedM55SN9/14/20229/28/20221/1/2023$614.40$8,426.06
DeniedF25SN10/6/202210/20/202210/6/2022$372.72$0.00
ClosedF58SN1/3/20231/17/20232/21/2023$414.00$2,129.15
ClosedF60SN2/13/20232/27/20238/27/2023$522.96$8,314.37
ClosedF35SN5/1/20235/15/20236/25/2023$622.08$1,244.16
ClosedF62SN2/10/20232/24/20234/18/2023$570.24$4,398.99
DeniedF66SN1/9/20231/10/2023$0.00
DeniedF29SN3/26/20234/9/20233/26/2023$576.24$0.00
ClosedF41SN5/26/20236/9/20237/9/2023$525.60$2,327.66
ClosedF44SN6/5/20236/22/202310/6/2023$535.44$8,184.59
ClosedF37AN4/26/20235/10/202311/3/2023$444.00$5,185.37
ClosedF45SN6/12/20236/26/20237/23/2023$563.76$1,528.36
ClosedF25SN7/8/20237/22/20238/20/2023$515.99$2,211.39
ClosedF28SN7/17/20237/31/20231/28/2024$646.08$13,513.84
ClosedF41SN8/14/20238/28/20239/9/2023$579.60$1,076.40
DeniedM41AN9/16/20239/30/20239/15/2023$408.00$0.00
ClosedF41SN10/13/202310/27/202311/27/2023$541.44$2,475.16
ClosedF61SN10/30/202311/13/20235/12/2024$493.68$12,835.68
ClosedF49SN10/9/202310/23/202311/12/2023$604.80$1,814.40
ClosedF30SN3/15/20243/29/20244/25/2024$857.23$0.00
DeniedF23SN10/14/202310/28/202310/14/2023$550.32$0.00
ClosedM61SN12/9/202312/23/20236/21/2024$1,124.75$23,941.11
ClosedF38SN1/4/20241/18/20243/21/2024$777.44$6,683.17
ClosedM55SN1/8/20241/22/20242/4/2024$667.20$692.20
ClosedF33SN3/16/20243/30/20246/2/2024$495.54$4,601.45
ClosedF24SN6/26/20247/10/20248/15/2024$450.96$2,383.64
DeniedF41SN9/30/202410/14/20249/30/2024$780.24$0.00
ClosedF57SN9/10/20249/24/20241/12/2025$613.20$9,723.60
ClosedF33SN10/8/202410/22/202411/18/2024$836.78$3,347.12
ClosedF26SN12/9/202412/23/20245/31/2025$535.92$11,892.32
ClosedM48SN1/9/20251/23/20253/2/2025$753.84$4,523.04
ClosedF27SN2/8/20252/22/20254/15/2025$550.08$4,164.90
DeniedF54SN11/16/202411/30/202411/16/2024$608.40$0.00
ClosedF46SN12/31/20241/14/20252/24/2025$559.44$3,356.64
DeniedF49SN1/27/20252/10/20251/27/2025$566.64$0.00
ClosedF50SN1/10/20251/24/20257/24/2025$463.92$11,863.10
OpenF61SN4/21/20255/5/20258/5/2025$1,001.52$11,590.51
ClosedF53SN5/29/20256/12/20257/6/2025$566.64$2,023.71
OpenF35SN5/19/20256/2/20258/15/2025$566.64$4,533.12
OpenF53SN4/24/20255/8/20258/14/2025$730.56$8,453.62
SuspendedF31SN7/1/20257/15/20257/28/2025$488.16$976.32
ClosedF59SN5/27/20256/10/20257/21/2025$754.80$3,903.26
PendingF0SN8/14/2025$0.00
ClosedM34SN5/21/20216/4/202112/2/2021$655.73$11,334.76
ClosedF29SN10/1/202110/15/202110/17/2021$476.16$204.07
ClosedM49AN10/23/202111/6/20215/6/2022$1,157.12$30,085.12
ClosedF54SN12/27/20211/10/20224/24/2022$559.44$8,391.60
ClosedF32SN12/6/202112/20/20211/30/2022$384.00$2,304.00
ClosedF41SN1/17/20221/31/20223/14/2022$715.44$4,394.85
ClosedF50SN3/30/20224/13/20225/4/2022$669.05$1,642.70
ClosedF53SN5/15/20225/29/202210/1/2022$498.96$8,981.28
DeniedF55SN5/20/20226/3/20226/1/2022$1,157.17$0.00
ClosedF40SN10/6/202210/20/202211/4/2022$629.04$1,282.31
ClosedF64SN9/29/202210/13/20224/12/2023$414.96$10,670.40
ClosedF57SN1/30/20232/13/20232/26/2023$582.24$413.16
ClosedF27SN8/8/20228/22/20222/19/2023$628.80$2,169.11
DeniedF52SN2/20/20233/6/20232/20/2023$949.28$0.00
ClosedF33SN3/17/20233/31/20235/11/2023$669.23$3,505.57
ClosedM61SN4/23/20235/7/20238/31/2023$1,088.75$18,197.68
ClosedF60SN5/10/20235/24/20236/13/2023$511.20$2,117.83
ClosedM43SN5/12/20235/26/20238/29/2023$704.16$9,657.05
DeniedF58SN7/25/20238/8/20237/25/2023$425.28$0.00
ClosedF59SN7/21/20238/4/202310/15/2023$633.60$6,607.54
ClosedF50SN7/27/20238/10/20232/12/2024$481.44$12,517.44
ClosedF60SN6/12/20236/26/202311/5/2023$463.20$7,471.92
DeniedF53SN8/25/20239/8/20238/25/2023$608.16$0.00
ClosedF47SN7/11/20237/25/202310/19/2023$574.08$7,027.35
ClosedM41AN9/16/20239/30/20233/11/2024$408.00$9,558.86
ClosedF33SN9/15/20239/29/202311/19/2023$408.00$3,030.86
ClosedF31SN10/9/202310/23/202312/1/2023$525.60$3,003.43
ClosedF38SN10/18/202311/1/202312/3/2023$535.44$2,159.62
ClosedF60SN11/22/202312/6/20235/8/2024$459.36$6,820.77
DeniedF23SN1/13/20241/27/20241/13/2024$450.00$0.00
ClosedF25SN4/11/20244/25/20245/22/2024$571.44$2,285.76
DeniedM60AY11/4/20232/23/202411/4/2023$1,256.89$0.00
ClosedF36SN3/21/20244/4/20249/16/2024$571.44$13,551.29
ClosedM52SN4/2/20244/16/20245/27/2024$829.92$4,979.52
ClosedF32SN2/13/20242/27/20244/19/2024$571.44$734.71
ClosedF61SN3/27/20244/10/20247/28/2024$918.24$14,352.97
ClosedF66SN5/9/20245/23/20248/7/2024$520.80$4,910.40
DeniedF47SN5/14/20245/28/20245/14/2024$450.00$0.00
ClosedF41SN7/29/20248/12/20249/15/2024$1,099.68$5,498.40
DeniedF30SN9/2/20249/16/20249/2/2024$547.44$0.00
DeniedF38SN10/16/202410/30/202410/16/2024$817.92$0.00
DeniedF52SN9/23/202410/7/20249/23/2024$596.88$0.00
DeniedF29SN10/29/202411/12/202410/29/2024$547.44$0.00
ClosedM63SN10/29/202411/12/20244/6/2025$778.80$16,243.54
ClosedF37SN11/27/202412/11/20243/2/2025$481.20$5,636.91
OpenF48SN1/17/20251/31/20257/31/2025$912.48$11,745.58
DeniedF42SN12/19/20241/2/202512/19/2024$817.20$0.00
ClosedF42SN3/20/20244/3/20245/28/2024$857.23$486.22
ClosedF62AN11/29/202412/13/20243/16/2025$586.32$7,873.44
DeniedF26SN1/14/20251/28/20251/14/2025$462.00$0.00
OpenF46SN6/30/20257/14/20258/10/2025$550.56$1,101.12
DeniedF25SY6/20/20257/4/20256/20/2025$715.92$0.00
PendingF0SN5/16/2025$0.00
ClosedM33SN8/12/20218/26/20212/23/2022$484.56$11,416.84
ClosedF34SN10/23/202111/6/20215/30/2022$599.28$15,581.28
ClosedF54SN12/9/202112/23/20213/6/2022$542.16$5,731.41
DeniedF36SN1/5/20221/19/20221/6/2022$476.64$0.00
ClosedF41SN1/9/20221/23/20222/21/2022$506.16$725.78
ClosedF48SN6/7/20216/21/202112/19/2021$528.24$6,613.06
DeniedM67SN9/15/20219/29/20219/15/2021$471.12$0.00
ClosedF42SN2/15/20223/1/20224/11/2022$593.28$508.53
ClosedM65SN3/23/20224/6/20225/15/2022$692.88$3,959.31
DeniedF36SN7/28/20228/11/20227/28/2022$525.12$0.00
DeniedM31SN6/22/20227/6/20226/22/2022$571.68$0.00
ClosedF66SN6/9/20226/23/20227/26/2022$330.00$1,048.40
ClosedF40SN9/26/202210/10/202210/23/2022$527.28$1,355.86
ClosedF34SN8/8/20228/22/20222/5/2023$451.44$8,562.94
ClosedF31SN9/8/20229/22/202210/21/2022$530.40$2,273.15
ClosedF51AN9/30/202210/14/20225/20/2023$760.56$12,767.35
ClosedF66SN10/21/202211/4/20224/11/2023$570.24$12,952.60
DeniedF30SN1/12/20231/26/20233/14/2023$421.68$0.00
ClosedF43SN2/1/20232/15/20237/31/2023$573.36$13,023.46
ClosedF56SN2/17/20233/3/20238/31/2023$729.36$17,450.45
ClosedF34SN5/18/20236/1/20236/28/2023$634.32$2,537.28
ClosedM60SN6/15/20236/29/20237/30/2023$600.72$2,746.15
ClosedF39SN5/30/20236/13/20237/1/2023$701.04$1,902.82
ClosedF31SN9/15/20239/29/202310/25/2023$646.56$1,662.58
ClosedF44SN6/29/20237/13/20237/26/2023$686.04$1,372.08
ClosedF59AN6/28/20237/12/202312/11/2023$673.44$13,807.35
ClosedF60SN9/6/20239/20/20233/19/2024$724.32$18,651.27
ClosedM57SN10/27/202311/10/20231/22/2024$607.68$2,841.15
ClosedF44SN9/26/202310/10/202312/25/2023$553.44$5,771.59
ClosedF59SN12/19/20231/2/20247/1/2024$425.28$11,057.28
ClosedF62SN9/20/202310/4/202310/8/2023$612.24$437.31
ClosedF44SN1/29/20242/12/20245/7/2024$857.23$10,670.45
DeniedF62SN2/8/20242/22/20242/8/2024$491.52$0.00
ClosedF32SN1/19/20242/2/20247/22/2024$535.44$13,156.52
ClosedF62SN2/23/20243/8/20249/5/2024$636.24$15,765.49
DeniedF35SN4/16/20244/30/20244/16/2024$716.64$0.00
ClosedF51SN4/12/20244/26/20247/7/2024$636.24$6,635.08
ClosedM59SN6/19/20247/3/20249/10/2024$809.30$5,896.34
ClosedF43SN7/1/20247/15/20248/11/2024$587.04$2,348.16
ClosedF64SN5/7/20245/21/20247/14/2024$622.80$4,893.43
ClosedF32SN8/16/20248/30/20249/30/2024$588.96$2,692.39
ClosedF61SN6/15/20246/29/202412/27/2024$762.96$19,618.97
ClosedM66SN6/14/20246/28/202412/17/2024$711.36$17,580.76
ClosedM59SN6/26/20247/10/20247/28/2024$713.76$1,937.35
DeniedM56SN8/9/20248/23/20248/9/2024$778.56$0.00
ClosedF41SN10/25/202411/8/202412/18/2024$1,300.56$7,617.56
ClosedF50SN9/2/20249/16/20249/29/2024$583.20$1,749.60
ClosedF53SN8/31/20249/14/202410/20/2024$707.04$3,737.21
ClosedF58SN12/3/202412/17/20241/26/2025$834.28$2,661.86
ClosedF23SN9/26/202410/10/202411/10/2024$535.92$2,296.80
ClosedF53SN10/1/202410/15/202411/3/2024$545.52$1,558.63
ClosedF60SN9/16/20249/30/20243/30/2025$582.56$5,234.76
ClosedM54SN11/26/202412/10/202412/29/2024$700.80$2,002.29
DeniedF46SN10/18/202411/1/202410/27/2024$653.04$0.00
ClosedF33SN11/4/202411/18/20243/30/2025$674.16$11,310.15
ClosedM59SN10/31/202411/14/202412/16/2024$547.44$1,984.47
DeniedF28SN4/2/20254/16/20254/2/2025$696.24$0.00
SuspendedF36SN3/18/20254/1/20257/18/2025$566.64$8,823.39
ClosedF50SN3/31/20254/14/20255/11/2025$728.16$2,912.64
ClosedM66SN3/21/20254/4/20255/11/2025$601.20$711.91
OpenF32AN3/29/20254/12/20258/24/2025$507.36$7,755.36
ClosedF70SN4/14/20254/28/20257/13/2025$546.96$6,016.56
ClosedF42SN5/16/20255/30/20256/29/2025$1,129.92$5,003.93
ClosedF32SN1/23/20252/6/20255/9/2025$566.64$1,518.20
PendingF42SN7/8/20257/22/20257/8/2025$897.12$0.00
PendingF40SN7/16/20257/30/2025$627.36$0.00
ClosedF52SN11/1/202111/15/20211/23/2022$485.52$250.00
ClosedF38SN11/11/202111/25/20213/9/2022$506.16$6,941.62
ClosedM70SN10/25/202111/8/202111/28/2021$385.68$991.75
ClosedF51SN1/24/20222/7/20224/17/2022$566.88$5,668.80
ClosedF37SN5/22/20226/5/20226/18/2022$557.52$1,115.03
ClosedM31SN9/29/202210/13/20224/12/2023$571.68$14,863.68
ClosedM49SN10/17/202210/31/202211/20/2022$607.44$1,822.32
DeniedF29SN2/7/20232/21/202312/6/2022$409.44$0.00
ClosedF51SN1/11/20231/25/20232/12/2023$468.96$1,272.89
DeniedF29SN1/17/20231/31/20231/17/2023$601.92$0.00
ClosedM61SN1/26/20232/9/20238/13/2023$740.88$6,925.67
ClosedF42SN2/13/20232/27/20235/15/2023$723.36$5,266.86
ClosedF24SN5/7/20235/21/20236/25/2023$547.44$177.14
ClosedM58SN2/24/20233/10/20234/16/2023$1,500.00$8,142.85
ClosedF61SN4/18/20235/2/20237/16/2023$454.85$4,938.37
ClosedM48SN2/10/20232/24/20235/18/2023$526.32$4,287.13
ClosedF59SN3/9/20233/23/20237/4/2023$443.76$5,388.51
ClosedF58AN4/22/20235/6/202311/3/2023$547.44$11,073.80
ClosedF64SN4/18/20235/2/202310/30/2023$480.96$7,554.54
DeniedM45SN5/22/20236/5/20235/22/2023$733.92$0.00
ClosedM33SN6/26/20237/10/202310/1/2023$711.60$9,962.40
ClosedF44SN7/3/20237/17/20239/26/2023$564.72$5,808.55
ClosedF38SN7/1/20237/15/20238/26/2023$952.13$5,214.08
ClosedF57SN8/14/20238/28/20239/24/2023$419.22$1,676.88
ClosedF56SN9/28/202310/12/202311/5/2023$585.84$3,529.33
ClosedF60SN11/30/202312/14/20231/17/2024$612.24$3,061.20
ClosedF47SN10/13/202310/27/202311/26/2023$541.44$2,397.81
ClosedF63SN10/14/202310/28/20231/18/2024$489.36$5,802.42
DeniedF34SN2/5/20242/19/20242/5/2024$716.64$0.00
ClosedF63SN4/18/20235/2/202310/30/2023$846.72$650.00
DeniedF29SN11/30/202312/14/202311/30/2023$420.00$0.00
ClosedF64SN12/24/20231/7/20244/7/2024$572.88$6,519.92
ClosedF46SN1/17/20241/31/20244/9/2024$591.36$5,913.60
ClosedF37SN4/12/20244/26/20245/27/2024$597.36$2,730.79
ClosedF47SN1/24/20242/7/20247/22/2024$805.44$19,215.49
ClosedF41SN7/13/20247/27/202410/8/2024$855.84$9,047.46
ClosedF34SN2/29/20243/14/20243/28/2024$636.24$1,363.37
ClosedF51SN5/10/20245/24/202411/21/2024$677.76$17,621.76
ClosedF47SN5/7/20245/21/20247/21/2024$636.24$5,635.27
DeniedF66SN7/16/20247/30/20247/16/2024$642.72$0.00
ClosedM52SN6/10/20246/24/20247/22/2024$1,122.48$4,650.27
DeniedF31SN7/26/20248/9/20247/26/2024$547.44$0.00
ClosedM53SN10/21/202411/4/20241/3/2025$685.20$5,971.03
ClosedF46SN10/16/202410/30/20244/29/2025$547.44$14,233.44
ClosedF38SN1/18/20252/1/20252/28/2025$480.00$1,920.00
ClosedF52AN2/15/20253/1/20255/15/2025$677.04$7,350.72
PendingF32SN7/16/20257/30/20257/16/2025$585.12$0.00
DeniedF54SN6/9/20256/23/20256/9/2025$826.08$0.00
PendingF45SN7/22/20258/5/20257/22/2025$655.44$0.00
DeniedM61SN6/7/20206/21/20206/5/2020$25.00$0.00
ClosedF60SN7/31/20218/14/20212/11/2022$1,157.42$28,936.88
ClosedF57SN2/2/20222/16/20223/15/2022$581.52$1,354.19
ClosedF35SN3/5/20223/19/20227/24/2022$902.17$8,351.67
DeniedF49SN4/25/20225/9/20224/25/2022$546.24$0.00
ClosedM49SN6/2/20226/16/202212/15/2022$582.57$14,536.52
ClosedF31SN7/4/20227/18/20228/14/2022$671.09$2,460.67
ClosedF46SN8/1/20228/15/20222/12/2023$591.36$14,981.12
ClosedF54SN9/13/20229/27/202210/26/2022$562.56$2,410.97
ClosedF50SN1/18/20232/1/20234/2/2023$1,011.73$8,485.24
ClosedF46SN12/9/202112/23/20215/12/2022$379.92$6,006.60
ClosedM56SN2/28/20233/14/20239/11/2023$872.88$15,777.10
ClosedF43SN5/1/20235/15/20236/21/2023$672.59$3,410.99
ClosedF55SN6/5/20236/19/20237/31/2023$652.56$4,008.58
ClosedF46SN10/25/202311/8/20231/21/2024$589.68$6,318.00
DeniedF41SN9/25/202310/9/202310/8/2023$709.20$0.00
ClosedM57SN10/26/202311/9/202312/17/2023$1,023.84$5,704.25
ClosedM59SN11/30/202312/14/20231/11/2024$438.00$1,814.58
ClosedM58SN1/5/20241/19/20243/16/2024$612.00$4,980.69
ClosedF63SN2/7/20242/21/20244/30/2024$636.24$6,362.40
ClosedF44SN2/26/20243/11/20244/21/2024$500.16$3,000.96
ClosedM34SN6/17/20247/1/20247/28/2024$638.16$1,326.32
ClosedF52SN9/27/202410/11/202412/22/2024$1,148.88$10,449.34
ClosedF39SN8/16/20248/30/202410/14/2024$716.88$2,355.46
ClosedF46SN10/1/202410/15/20244/14/2025$1,253.04$29,063.22
DeniedM27SN9/4/20249/18/20249/17/2024$492.48$0.00
ClosedF51SN10/16/202410/30/202411/10/2024$591.84$1,014.59
ClosedF39SN10/22/202411/5/202412/22/2024$565.44$3,877.30
ClosedF22SN12/2/202412/16/20241/14/2025$485.04$698.62
ClosedF62SN9/24/202410/8/202412/1/2024$506.40$917.20
ClosedF46SN1/30/20252/13/20254/9/2025$583.20$1,616.34
ClosedM59AN11/23/202412/7/20246/6/2025$754.56$19,618.56
ClosedF36SN2/19/20253/5/20254/3/2025$566.64$944.00
ClosedF31SN6/3/20256/17/20257/20/2025$832.56$4,043.86
ClosedM48SN4/27/20255/11/20257/22/2025$734.40$7,658.74
ClosedF50SN5/19/20256/2/20256/11/2025$566.64$809.49
DeniedF45SN4/15/20254/29/20254/29/2025$581.52$0.00
OpenF45AN5/23/20256/6/20258/17/2025$745.44$3,990.18
DeniedF38SY7/8/20257/22/20257/8/2025$27.00$0.00
DeniedF57SN7/6/20257/20/20257/6/2025$681.84$0.00
PendingF32SN7/21/20258/4/20257/21/2025$717.12$0.00
ClosedF49SN4/1/20214/15/20217/1/2021$411.48$2,104.03
ClosedF64SN10/13/202110/27/20212/6/2022$759.36$6,850.76
ClosedF50SN10/29/202111/12/20211/31/2022$526.32$5,739.40
ClosedF62SN10/26/202111/9/20211/27/2022$432.24$1,736.58
ClosedF32SN12/17/202112/31/20216/13/2022$397.44$8,647.99
ClosedF57SN12/15/202112/29/20212/25/2022$428.68$2,773.41
ClosedF46SN1/26/20222/9/20228/9/2022$458.64$11,924.64
ClosedF34SN1/31/20222/14/20223/4/2022$489.36$1,328.26
ClosedF36SN4/28/20225/12/20226/22/2022$601.92$3,582.86
DeniedF26SN5/7/20225/21/20225/8/2022$496.32$0.00
ClosedM31SN3/29/20224/12/20225/10/2022$611.52$2,970.24
ClosedF30SN4/30/20225/14/20226/7/2022$546.24$1,950.86
ClosedF59SN4/26/20225/10/20228/7/2022$414.24$5,325.95
DeniedF38SN8/13/20228/27/202210/11/2022$546.24$0.00
DeniedF37SN8/8/20228/22/20228/8/2022$662.40$0.00
ClosedF33SN8/22/20229/5/202210/9/2022$530.40$2,563.60
ClosedF28SN9/7/20229/21/202211/3/2022$754.08$4,739.93
ClosedF54AN9/8/20229/22/202212/1/2022$394.08$3,997.10
ClosedF29SN8/24/20229/7/202210/2/2022$576.48$2,022.01
ClosedM42SN11/8/202211/22/20225/22/2023$959.03$20,667.72
ClosedF24SN12/1/202212/15/20222/14/2023$573.36$4,313.85
ClosedF32SN1/10/20232/1/20233/16/2023$451.44$2,837.63
ClosedF45SN1/27/20232/10/20232/23/2023$441.60$883.20
DeniedM24SN5/23/20236/6/20235/23/2023$535.44$0.00
ClosedF49SN1/17/20231/31/20232/9/2023$574.80$711.65
ClosedF31SN12/24/20221/7/20236/4/2023$763.10$6,934.82
DeniedF41SN5/22/20236/5/20235/22/2023$520.80$0.00
DeniedF38SN3/1/20233/15/20233/1/2023$878.16$0.00
DeniedF33SN7/10/20237/24/20238/6/2023$547.44$0.00
ClosedF53SN10/5/202310/19/202312/3/2023$448.80$2,949.26
ClosedF24SN9/19/202310/3/202310/30/2023$566.40$1,801.54
ClosedM37SN9/7/20239/21/202312/1/2023$447.84$4,606.36
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
ClosedF51SN11/16/202311/30/20232/12/2024$525.60$5,631.43
ClosedM65SN11/3/202311/17/20231/1/2024$1,050.24$2,525.79
ClosedF51SN4/29/20245/13/20247/21/2024$918.72$9,187.20
ClosedF66SN3/15/20243/29/20249/26/2024$688.56$17,902.56
ClosedF36SN5/14/20245/28/20246/24/2024$1,168.32$4,673.28
ClosedM49SN7/9/20247/23/20248/1/2024$1,300.56$35.71
ClosedM50SN7/18/20248/1/202410/27/2024$603.12$3,016.54
DeniedM65AN9/20/202410/4/20249/20/2024$686.40$0.00
ClosedF60SN10/22/202411/5/20241/20/2025$657.84$7,236.24
ClosedF43SN3/13/20253/27/20253/30/2025$617.52$617.52
ClosedF58SN4/4/20254/18/20255/9/2025$828.24$2,563.60
OpenF41SN6/6/20256/20/20258/3/2025$529.20$996.49
PendingM50SN5/10/20255/24/20255/10/2025$578.16$0.00
PendingF0SN6/16/2025$0.00
ClosedF53SN7/28/20218/11/20212/8/2022$506.16$10,918.60
ClosedF45SN11/20/202112/4/20211/23/2022$506.16$3,687.74
ClosedF22SN12/12/202112/26/20212/5/2022$371.28$2,227.68
ClosedF61SN4/4/20224/18/20227/3/2022$526.32$5,789.52
ClosedF52SN1/18/20222/1/20228/1/2022$739.92$19,237.92
ClosedF63SN12/20/20211/3/20227/12/2022$409.44$9,807.05
ClosedF52SN11/30/202112/14/20212/13/2022$649.92$1,981.10
DeniedM37SN3/4/20223/18/20223/4/2022$369.84$0.00
ClosedF61AN4/26/20225/10/20227/31/2022$915.12$5,615.72
ClosedF43SN6/14/20226/28/20229/13/2022$783.80$6,856.10
ClosedF43SN7/20/20228/3/202210/10/2022$568.56$5,604.37
ClosedF27SN6/29/20227/13/202212/14/2022$601.92$12,239.04
ClosedF37SN7/1/20227/15/20228/2/2022$591.36$387.92
ClosedF40SN7/26/20228/9/20229/4/2022$581.28$2,408.16
ClosedF59SN8/8/20228/22/202211/2/2022$435.12$4,289.04
ClosedF58SN9/9/20229/23/202210/20/2022$599.89$2,399.56
ClosedF39SN10/12/202210/26/20221/4/2023$793.92$5,391.32
ClosedF24SN10/22/202211/5/202212/4/2022$491.52$2,106.51
ClosedF26SN12/20/20221/3/20232/13/2023$677.76$2,854.29
ClosedF50SN12/8/202212/22/20222/12/2023$636.00$907.14
DeniedF38SN3/2/20233/16/20233/2/2023$570.24$0.00
ClosedF56SN3/27/20234/10/20235/14/2023$585.84$2,929.20
ClosedF53SN12/13/202212/27/20226/11/2023$1,157.17$15,314.64
ClosedF32SN4/5/20234/19/20234/30/2023$470.40$806.40
ClosedF57SN5/3/20235/17/20235/21/2023$419.22$299.44
DeniedF20SN6/20/20237/4/20236/20/2023$25.00$0.00
DeniedF45SN7/18/20238/1/20237/18/2023$597.60$0.00
ClosedF35SN8/6/20238/20/20239/16/2023$883.97$5,303.82
ClosedF49SN7/19/20238/2/20231/30/2024$728.88$18,950.88
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
ClosedF33SN10/2/202310/16/202312/10/2023$535.44$4,360.01
DeniedM44AY5/22/20236/5/202310/26/2023$1,482.78$0.00
ClosedM30SN11/14/202311/28/202312/3/2023$605.04$518.61
ClosedF62SN2/8/20242/22/20248/22/2024$591.84$13,133.21
ClosedF41SN4/29/20245/13/20245/19/2024$571.44$1,142.88
ClosedF52SN5/1/20245/15/20246/9/2024$687.60$2,553.94
DeniedF30SN3/21/20244/4/20243/21/2024$647.76$0.00
ClosedF26SN4/9/20244/23/20246/4/2024$535.92$2,832.72
DeniedF59SN6/4/20246/18/20246/4/2024$580.32$0.00
DeniedF64SN4/23/20245/7/20244/23/2024$637.44$0.00
ClosedF35SN8/5/20248/19/202411/3/2024$691.92$7,149.84
DeniedF38SN10/16/202410/30/202410/16/2024$817.92$0.00
ClosedM61SN10/22/202411/5/20245/5/2025$796.08$20,698.08
ClosedM46AN11/1/202411/15/20245/15/2025$552.00$10,964.14
ClosedF53SN12/30/20241/13/20253/23/2025$687.60$6,876.00
ClosedF51SN11/20/202412/4/202412/22/2024$878.16$2,093.47
ClosedF47SN4/4/20254/18/20255/18/2025$468.00$2,072.57
ClosedF30SN1/30/20252/13/20257/30/2025$520.38$2,973.60
ClosedF59SN6/9/20216/23/202112/12/2021$688.80$13,421.06
ClosedF41SN10/13/202110/27/20214/26/2022$510.96$11,922.41
ClosedF51SN11/29/202112/13/20211/10/2022$566.40$2,346.51
ClosedF53SN12/29/20211/11/20221/30/2022$752.62$5,235.10
DeniedF31SN2/1/20222/15/20222/1/2022$536.40$0.00
ClosedF31SN2/3/20222/17/20223/27/2022$442.34$2,464.47
DeniedF35SN3/12/20223/26/20223/12/2022$902.17$0.00
ClosedF36SN4/7/20224/21/20226/1/2022$599.28$2,682.49
ClosedF46SN5/26/20226/9/202211/13/2022$520.08$11,738.95
ClosedM66SN8/31/20229/14/202212/18/2022$692.88$10,888.11
ClosedM58SN8/31/20229/14/202210/12/2022$752.88$2,760.56
ClosedF25SN6/15/20226/29/20228/11/2022$551.76$1,737.42
ClosedF36AN9/2/20229/16/202210/2/2022$546.24$727.31
ClosedF45SN11/9/202211/23/20225/23/2023$642.96$16,410.79
ClosedF47SN11/9/202211/23/20221/8/2023$630.00$3,690.00
ClosedM47SN11/21/202212/5/202212/25/2022$696.72$2,786.88
ClosedF50SN10/24/202211/7/202211/15/2022$513.60$660.34
ClosedF29SN1/25/20232/8/20233/26/2023$409.44$2,749.10
ClosedF37SN1/25/20232/8/20233/22/2023$808.08$4,963.92
ClosedF31SN1/12/20231/26/20232/22/2023$601.92$1,314.83
ClosedM58SN3/22/20234/5/20234/23/2023$620.88$1,685.25
ClosedF65SN3/17/20233/31/20234/16/2023$487.68$1,184.37
DeniedF59SN6/29/20237/13/20236/29/2023$473.52$0.00
ClosedF34SN4/26/20235/10/20236/11/2023$554.40$2,613.60
ClosedF33SN4/25/20235/9/20236/8/2023$456.84$1,238.61
DeniedF29SN5/12/20235/26/20235/12/2023$418.56$0.00
ClosedF50SN6/30/20237/14/202311/5/2023$653.76$10,740.34
ClosedM63SN6/26/20237/10/20231/7/2024$581.76$7,862.88
ClosedF38SN8/7/20238/21/202310/1/2023$612.72$2,884.36
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
DeniedF30SN7/26/20238/9/20237/26/2023$511.44$0.00
ClosedM34SN1/16/20241/30/20247/29/2024$716.88$18,638.88
ClosedF69SN2/5/20242/19/20243/3/2024$496.56$993.12
ClosedF32SN3/1/20243/15/20245/29/2024$565.44$2,896.42
ClosedF36AN3/26/20244/9/20246/25/2024$652.80$4,798.85
ClosedF56SN1/25/20242/8/20246/9/2024$737.14$2,168.77
ClosedF34SN5/2/20245/16/20246/12/2024$571.44$100.00
ClosedM39SN6/14/20246/28/202412/26/2024$693.84$17,742.48
DeniedF31SN8/16/20248/30/20248/16/2024$608.16$0.00
ClosedF48SN8/28/20249/11/202411/10/2024$631.92$5,506.73
ClosedM35AN9/22/202410/6/202411/3/2024$730.32$3,025.61
DeniedF43SN10/30/202411/13/202410/30/2024$565.44$0.00
ClosedF64SN12/6/202412/20/20246/19/2025$557.28$14,489.28
DeniedM56SN11/13/202411/27/202411/13/2024$1,300.56$0.00
ClosedF42SN2/24/20253/10/20254/6/2025$810.48$2,971.76
ClosedF61SN1/13/20251/27/20252/2/2025$621.36$621.36
ClosedF47SN2/12/20252/26/20253/23/2025$1,134.48$92.86
ClosedF46SN3/28/20254/11/20254/24/2025$720.48$1,440.96
OpenF44SN4/3/20254/17/20258/29/2025$1,116.00$15,064.43
OpenM64SN5/12/20255/26/20259/25/2025$879.60$7,916.40
OpenF57SN5/29/20256/12/20259/8/2025$612.00$4,021.71
PendingM67SN8/19/20259/2/2025$576.00$0.00
PendingF34SN6/24/20257/10/2025$563.04$0.00
ClosedF32SN9/10/20219/24/20213/24/2022$516.24$13,422.24
ClosedM56AN11/19/202112/3/20212/13/2022$502.80$5,099.83
ClosedM45SN11/19/202112/3/20216/3/2022$1,157.10$30,084.60
ClosedF57SN11/11/202111/25/20211/9/2022$429.60$2,013.89
DeniedM35SN1/10/20221/24/20221/30/2022$379.92$0.00
ClosedF28SN1/26/20222/9/20222/22/2022$364.80$689.46
ClosedF57SN2/15/20223/1/20223/6/2022$544.80$466.97
ClosedF51SN4/18/20225/2/20225/18/2022$595.68$1,446.65
ClosedF53SN4/5/20224/19/202210/17/2022$388.32$8,694.94
DeniedF30SN8/3/20228/17/20228/3/2022$482.14$0.00
ClosedF63SN6/2/20226/16/20226/27/2022$628.38$1,077.22
DeniedF43SN7/5/20227/19/20227/5/2022$594.72$0.00
ClosedF25SN6/28/20227/12/20228/8/2022$601.92$594.50
DeniedF58SN10/15/202210/29/202210/23/2022$544.80$0.00
DeniedF31SN12/15/202212/29/202212/15/2022$763.10$0.00
DeniedF29SN1/25/20232/8/202311/29/2022$409.44$0.00
ClosedF22SN2/4/20232/18/20233/26/2023$494.40$2,448.46
ClosedF31SN5/28/20236/11/20237/9/2023$772.56$3,200.61
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
ClosedF50SN12/29/20231/12/20242/11/2024$477.84$2,116.15
ClosedF56SN1/10/20241/24/20245/15/2024$583.44$9,418.39
DeniedM37AY1/24/20242/7/20241/24/2024$694.56$0.00
DeniedF50SN3/28/20244/11/20244/8/2024$669.36$0.00
DeniedF23SN3/28/20244/11/20244/1/2024$535.92$0.00
ClosedM47SN5/21/20246/4/20246/30/2024$753.84$2,907.67
ClosedF39AN6/1/20246/15/20247/21/2024$565.44$2,827.20
ClosedF47SN7/15/20247/29/202412/13/2024$491.40$9,687.60
DeniedF41SN11/13/202411/27/202411/13/2024$503.04$0.00
ClosedF52SN12/3/202412/17/20241/1/2025$555.60$1,587.43
ClosedF65SN12/16/202412/30/20244/6/2025$615.12$745.46
ClosedF51SN1/15/20251/29/20255/4/2025$673.68$9,239.04
DeniedF45SN2/5/20252/19/20252/5/2025$581.52$0.00
SuspendedM54SN4/23/20255/7/20257/18/2025$791.10$7,873.35
DeniedF67SN4/2/20254/16/20254/2/2025$698.40$0.00
DeniedF28SN3/18/20254/1/20253/18/2025$601.20$0.00
SuspendedM67SN5/29/20256/12/20257/23/2025$747.36$4,484.16
SuspendedF33SN5/29/20256/12/20257/28/2025$579.12$3,888.38
OpenF54SN7/9/20257/23/20258/19/2025$566.64$404.74
OpenM61SN7/8/20257/22/20258/21/2025$553.20$474.17
SuspendedM56SN6/25/20257/9/20257/22/2025$741.60$1,483.20
Total Claims for Customer 0157775 : 493Sum of Gross Benefit for Customer 0157775 : $2,234,179.52
8/13/2025 11:20:51 AMPage 2 of 2

File details come from the government source that posted it. Updated .